These first two weeks have been rocky for the state health insurance exchanges. The online marketplaces opened across the country Oct. 1, with computer glitches and staffing shortages. Even the states that have agreed to run their own are having a hard time. In states that have not embraced the Affordable Care Act, the federal government is struggling to fill in the gap. As Alexandra Dixon threads her way among the people waiting to see a doctor at the Community Clinic, Inc., in Silver Spring, Md., she introduces herself with a bright smile and an outstretched hand.