The Trump administration has directed U.S. consular and embassy officials to factor certain chronic medical conditions — including diabetes and obesity — into decisions about immigrant visas, according to a State Department cable reviewed by KFF Health News.
The guidance tells visa officers to deem applicants ineligible if health issues, age or a likelihood of relying on public benefits would make them a “public charge,” a potential drain on U.S. resources. While medical screening for immigrants has long focused on communicable diseases (such as tuberculosis) and required vaccinations, experts say the new directive significantly broadens which conditions may be considered and gives visa officers more discretion to judge applicants’ future health-care costs and ability to support themselves.
“You must consider an applicant’s health,” the cable states. “Certain medical conditions – including, but not limited to, cardiovascular diseases, respiratory diseases, cancers, diabetes, metabolic diseases, neurological diseases, and mental health conditions – can require hundreds of thousands of dollars’ worth of care.”
About 10% of the world’s population has diabetes, and cardiovascular diseases are the world’s leading cause of death, underscoring how common some of the listed conditions are. The cable also singles out obesity, noting it can contribute to asthma, sleep apnea and high blood pressure — conditions the guidance says could lead to expensive, long-term care. State Department spokespeople did not immediately respond to requests for comment on the cable.
Visa officers are instructed to assess whether applicants have the financial means to cover anticipated medical costs without turning to government assistance. The cable asks, “Does the applicant have adequate financial resources to cover the costs of such care over his entire expected lifespan without seeking public cash assistance or long-term institutionalization at government expense?”
Immigration advocates and legal experts warn this language clashes with the State Department’s Foreign Affairs Manual, which instructs officers not to base decisions on speculative “what if” scenarios. Charles Wheeler, a senior attorney with the Catholic Legal Immigration Network, said the guidance pushes officers to invent “their own thoughts about what could lead to some sort of medical emergency or sort of medical costs in the future,” even though they are not medically trained and risk applying personal bias.
The cable also directs officers to consider the health needs of dependents, asking whether children or elderly relatives have disabilities or chronic conditions that might prevent the applicant from maintaining employment.
Currently, immigrants seeking permanent residence must undergo a medical exam by a physician approved by a U.S. embassy. That exam screens for communicable diseases and requires applicants to complete a form disclosing histories of drug or alcohol use, mental health conditions or violence. Applicants must also meet vaccination requirements for diseases such as measles, polio and hepatitis B.
Sophia Genovese, an immigration attorney at Georgetown University, said the new guidance expands the scope of health-related assessment beyond communicable disease and vaccination status to include chronic disease histories and speculative projections about future medical emergencies and employability. “Taking into consideration one’s diabetic history or heart health history — that’s quite expansive,” she said, warning the change could create problems for applicants facing consular interviews if implemented immediately.
The directive is part of broader administration actions aimed at reducing immigration, a campaign that has included large-scale interior enforcement operations, restrictions on refugees and proposals to cut annual refugee admissions. KFF Health News, which examined the cable, is a national newsroom producing in-depth journalism about health issues and is part of the Kaiser Family Foundation.
