From Maryland to Hawaii, Obamacare’s state-run enrollment operations are running into technical difficulties, creating new headaches for the White House even as the federal insurance website finds its footing.

While the U.S. site has seen volumes surge this month, online exchanges run by those two states, along with systems in Massachusetts, Oregon and Hawaii, have struggled with technological delays and low sign-up levels. All but Massachusetts have replaced their top executives this month.

The stumbles threaten to undercut one of the few arguments favoring President Barack Obama’s health-care overhaul so far: its relatively smooth rollout in states that set up their own enrollment systems. While states such as California and New York remain bright spots, the administration can’t afford many more setbacks in the fight over the law.

“Some of these states have been committed, but it’s just been hurdle after hurdle after hurdle,” said Heather Howard, program director at the State Health Reform Assistance Network, a Princeton, New Jersey-based group advising state exchanges. “I do think those states will get there, but this is an ambitious undertaking in the best of cases.”

More than 2 million people visited the federal healthcare.gov site on Dec. 23, ahead of a deadline to sign up for insurance coverage that starts Jan. 1. Thirty-six states are using the federal portal. The remaining 14 and the District of Columbia have built their own marketplaces.

The exchanges offer health plans and access to subsidies created by the law, officially known as the Patient Protection and Affordable Care Act. They’re open to consumers who don’t get insurance through work or government programs like Medicare and Medicaid.

Successful Efforts

To be sure, there have been successes in the states. Almost 157,000 people in New York have signed up in private plans, John Emery, a spokesman for the state-run exchange, said in a Dec. 24 e-mail. California has enrolled more than 400,000, said Peter Lee, executive director of the state’s Covered California exchange. Kentucky and Washington State have also had a high level of interest.

Healthcare.gov has improved since an error-plagued debut on Oct. 1. Following a “tech surge” designed to fix its software flaws, more than 500,000 people enrolled through the site in the first three weeks of December, Obama said Dec. 20.

Difficult Starts

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