State by state, they have adopted the easier standards—but that could have been done without the exchanges, mandates, IPAB and all the rest.
Likely. But they could not have kept it so secret (at least in terms of generally disseminated knowledge) for three years without having it buried in the language of the virtually unread 2000 page+ PPACA bill.
For the last three years, most of the talk about PPACA was on birth control, keeping children on policies, insuring pre-existing conditions, etc. We find out that most of this talk was minutia compared to the kinds of things we are now finding out about, a significant expansion in Medicaid costs being one of them.