OAKLAND -- Ask most people in Alameda County what the letters ACMC stand for, and the response is usually a blank stare.

Even by its full name, the Alameda County Medical Center was at best synonymous with Highland Hospital, whose high-profile reputation for trauma care was a mixed blessing. Cultivating a better image drove executives to change the name to the Alameda Health System.

In less than a year, the Affordable Care Act will put Medi-Cal and private insurance within the grasp of many thousands more Alameda County residents. The county's public health network, which includes John George Psychiatric Pavilion and Highland Hospital, will have to compete for every expecting mother, diabetic, stroke victim and teenager with a broken bone.

The name change is a signal that things will be done differently, "that it's really a new day," said CEO Wright Lassiter III, referencing the organization's new motto. There's nothing wrong with being a safety-net hospital, "but we have to be that and more," he said.

The "It's a new day" branding blitz also involves new websites for each hospital and clinic and an expansion into southern Alameda County in order to consolidate and compete with Kaiser Permanente and other rivals, such as Sutter Health.

Everything is aimed at accomplishing two rival imperatives: appealing to the people who will now have insurance while continuing to serve as the safety-net provider for the county.

AHS has to be the provider of choice and provider of last resort, said Alex Briscoe, Alameda County health care services director. The two are not mutually exclusive, but it is a high-wire balancing act that the Affordable Care Act makes harder.

The organization is in the best financial shape in decades, but it still owes about $130 million to the county from the $200 million bailout in the 1990s. The health center would be crippled without county financial support and the half-cent Measure A sales tax, which during the most recently reported fiscal year, 2010-11, generated $105.5 million for health care services in Alameda County.

If AHS fails, "the county will have to pick up the pieces. That could mean closing facilities, " Briscoe told the county Board of Supervisors recently. "After Jan. 1, 2014, it's going to get tougher."

Lassiter had a different message for an adoring crowd gathered at the Scottish Rite Temple on Jan. 29 for the annual community forum.

"The future is looking brighter than ever," he announced to the room of doctors, nurses, board members, administrators and scores of people engaged in the survival of the medical center.

2012 was a good year, with a score card full of accolades and a healthy profit margin of 2.5 percent -- meaning ACMC kept 2½ cents of every dollar earned. That is a far cry from less than a decade ago, when the center bled red ink to the point of collapse.

The new bond-financed outpatient care pavilion at Highland Hospital opens in May, followed by the acute tower in 2015.

Last year also included the success of a documentary about Highland Hospital's emergency department, "Waiting Room," which Lassiter called "the best gift of 2012." Before the film, the waiting room meant time lost, Lassiter said. Now it represents the tapestry of this community and the compassion of the staff at ACMC, he said.

Despite the recognition, the name Alameda County Medical Center was an impediment to attracting people who have a choice, Lassiter said. Brand advisers told them to shed the word county, but East Bay was too broad. They needed a distinct identity that balanced all sorts of associations and didn't make people equate the larger entity with problems in any of the specific hospitals and clinics.

By 2022, AHS plans to have a network of 250,000 patients spanning the entire county, including several new clinics between Oakland and Dublin. John George will change from a pavilion to a hospital, and the clinic in Hayward will be become the Winton Wellness Center.

"The community will see we provide value beyond just trauma and beyond just Oakland," Lassiter said. "You won't come to our hospital, you'll come to our system."

Health care reform is pushing hospitals around the country to rebrand and consolidate. Analysts say concerns about survival are justified based on the past.

Back in the 1970s, when pregnant women gained access to private hospitals through changes to Medi-Cal, they went to facilities like Alta Bates in Berkeley. Some public facilities stopped doing labor and delivery altogether, Maribeth Shannon of the Oakland-based think tank California Healthcare Foundation said. "There are a lot of unknowns," she said.

Alameda County Supervisor Wilma Chan repeated Shannon's words verbatim, adding, "We're trying to be as prepared as possible."

The toughest job may be cutting spending because so many costs are outside the control of local operations. Health care in the United States is expensive, Lassiter said.

California's Medi-Cal reimbursements are low, relative to similar programs in other states, meaning AHS will continue to be under-reimbursed. Only there will be more Medi-Cal patients at the same time the program's subsidy ends.

And state health care exchanges, which will put insurance within the reach of people who otherwise could not afford it, won't fully compensate hospitals for the cost of care.

"We are trying to capture every single penny we deserve," Lassiter said. Billing is not the biggest issue, he added, "but it would be foolhardy not to try."

Administrators are betting on the savings that electronic health records will produce, although they still have to build a larger framework to reap the rewards.

Ultimately, AHS will survive or fail based on how well it serves patients. But it still has a long way to go before care in all parts of the system is consistent.

"I know we're not there yet," outgoing medical center trustee Daniel Boggan Jr. said in January at the community forum. "But at least the conversation has begun."