States are grappling with the challenge of making their health insurance exchanges functional by the Oct. 1 enrollment date, experts say. Washington, D.C. and 23 states have committed to running their own exchanges, while almost all other states have chosen to largely default to federal oversight. But the form and number of state exchanges may change over time, according to some experts. "Many of the states have just run out of time for a variety of reasons. I'd be surprised if in the longer run every state didn't want to have its own approach," said Christine Ferguson of the Rhode Island Health Benefits Exchange.