The Affordable Care act is having a devastating impact on already strapped rural hospitals, playing a role in many of them shutting their doors, The Washington Post reports.Forty-eight rural hospitals have closed since 2010 and 283 are in danger, the Post quotes the National Rural Health Association as saying. Most of the shuttered hospitals are in the South.Other factors are contributing to the problem, but Obamacare is cited as the main reason. The law reduced Medicare payments and how much hospitals are paid for uninsured patients.The law assumed states would increase Medicaid to cover the gap, but many states did not.Another factor caused by Obamacare: insurance plans with deductibles so high that people opt to skip some care they previously received. Fewer visits mean less revenue.Other factors hitting small rural hospitals are declining population and a higher percentage of uninsured and elderly patients. They also face the expense of paying doctors more to persuade them to work in small towns and to buy expensive medical equipment that doesn't get a lot of use.It isn't the first time rural hospitals have been hit, the Post noted.In 1983, the Medicare payment system was changed to allow for only fixed payments according to the type of care given. Smaller hospitals could not afford to provide care as cheaply as larger hospitals, and began shutting their doors.The policy was amended in 1997 to make exceptions for smaller hospitals."And now, beginning in 2010, we’ve had another series of cuts that are all combining to create another expansion of closures just like we saw in the '90s,” Brock Slabach of the Rural Health Association told the Post. "We don’t want to wake up with another disaster."Related Stories: