A State Department cable reviewed by KFF Health News instructs U.S. consular and embassy officials to factor certain chronic illnesses — including diabetes and obesity — into decisions on immigrant visas. The guidance directs visa officers to deem applicants ineligible if medical conditions, age or a likely need for public benefits would make them a “public charge,” potentially imposing a long-term cost on U.S. resources.
Historically, immigrant medical screening has focused on communicable diseases such as tuberculosis and on required vaccinations. The new directive broadens the scope by listing conditions like cardiovascular and respiratory diseases, cancers, metabolic and neurological disorders, and mental health conditions. The cable says such illnesses “can require hundreds of thousands of dollars’ worth of care.” It also highlights obesity as a factor that can contribute to asthma, sleep apnea and high blood pressure, which the guidance says could lead to expensive, ongoing treatment.
The memo asks officers to judge whether applicants have sufficient financial resources to cover anticipated medical costs without turning to government cash assistance or long-term institutional care, posing the question of whether an applicant can “cover the costs of such care over his entire expected lifespan.” State Department spokespeople did not immediately comment on the cable.
Immigration advocates and legal experts say this approach clashes with the State Department’s Foreign Affairs Manual, which warns against basing decisions on speculative “what if” scenarios. Charles Wheeler, a senior attorney at the Catholic Legal Immigration Network, said the guidance encourages officers to speculate about possible future medical emergencies and costs even though they lack medical training and could apply personal biases.
The cable also asks officers to consider the health needs of dependents, including children and elderly relatives whose disabilities or chronic conditions might affect the applicant’s ability to work.
Current immigrant medical exams, conducted by physicians approved by U.S. embassies, screen for communicable diseases, require vaccinations and include disclosure of drug or alcohol use, mental health histories and violence. Georgetown immigration attorney Sophia Genovese said the new guidance expands assessments well beyond infectious disease and immunization histories and could create major problems if applied immediately.
The directive is one element of broader administration efforts aimed at reducing immigration, alongside enhanced interior enforcement and tighter refugee policies. KFF Health News, which examined the cable, is a national newsroom focused on health reporting and is part of the Kaiser Family Foundation.