In the dark red states, sure. Not everywhere. Most places added those requirements 30 years ago.

It’s not just health care. Intrusive regulation like requiring a nominal amount of paid sick leave is mandated in my state over a certain number of hours. (32 iirc)

Incorrect. It seems mandates were state-by-state prior to the ACA, and certainly existed. Here's a quickly dredged up citation.

https://www.npr.org/sections/health-shots/2014/09/16/3489562...