On the morning after Sunday's vote to revamp the health care system, Bob Caulk contemplated the enormous task of extending health care coverage to the nation's millions of uninsured.

Caulk, chief executive officer of The Effort, spoke enthusiastically about expanding his nonprofit chain of clinics, based in midtown Sacramento, into more places.

"We're going to be ready, and other clinics are trying to gear up," Caulk said. "The question is: Where are you going to put all these people in a system that's not yet designed to accommodate them?"

Across the country, as many as 32 million of the country's 46 million uninsured could soon have improved access to affordable health insurance — through government subsidies or by becoming eligible for Medicaid programs such as Medi-Cal.

Whether the system will be ready to receive them remains a significant unknown. The influx of new patients may strain the nation's supply of primary care physicians. But at the same time, it could ease the burden on county clinics and emergency rooms, which currently provide care to those who lack insurance. Community clinics like The Effort could step up to serve more people.

Physicians groups have raised concerns about whether there will be enough primary care doctors to serve all the new subscribers.

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