Rhode Island has hit some speed bumps in its effort to be a leader in setting up a state-run health-insurance exchange. It fell behind several others in getting conditional approval by the Obama administration last month. Christine Ferguson, executive director of the R.I. Health Benefits Exchange, has said the latter might not be fully operational by the Jan. 1, 2014 deadline. And Rhode Island was still in negotiations this month with the potential contractor to build the core component of the exchange, the systems integrator. Above, members of a state health care reform commission, including Steven M. Costantino, secretary of Health and Human Services, foreground, meet last month.