"Question 7 of the worksheet says to "Enter the total paid for health insurance " which, I assume, is the amount we paid, out-of-pocket, for our ACA 2020 health plan each month"
Here you enter the amount out of pocket for health insurance premiums LESS any PTC that you were credited with at the end of the year. You are right to be suspicious - the state wants to know your NET health insurance premiums (which might be zero). Otherwise, you would be double-dipping - getting a deduction and a credit on the same dollars.
"Enter the total health insurance costs deducted elsewhere on the federal return ... "
This would be referring to any other health insurance not previously referred to on line 7. Actually, I am flying a bit blind here, because I am not easily finding this worksheet, but I can imagine what it wants to know.
This would refer to long-term care insurance, dental insurance, and other health insurance not in your original health policy (i.e., line 7). Note that you would not enter any premiums paid through your HSA, since you have already gotten the tax benefit from the contributions.
I would expect, given your description, that you would enter zero or close to it for line 7 (whatever the net amount is for your out-of-pocket premiums less refunded PTC), and zero for line 9.
Make sense?
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