(AI-generated photo)
New Delhi: Foreigners seeking entry to the United States could face new hurdles under a directive from the Trump administration that allows visa officers to deny applications based on chronic health conditions such as diabetes, obesity, and cardiovascular disease. The policy, revealed in a cable reviewed by KFF Health News, significantly broadens the interpretation of the “public charge” rule, raising concerns among immigration experts and advocates.
According to the cable sent by the US State Department to embassies and consular offices worldwide, visa officers are now required to consider applicants’ long-term health conditions and their potential financial burden on American resources. The directive lists a range of non-communicable illnesses — including metabolic and neurological diseases, mental health conditions, cancers, and respiratory disorders — as factors that may justify visa denial.
“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.” It further adds that such illnesses “can require expensive, long-term care,” which may make the applicant a likely “public charge”.
Broader Discretion for Visa Officers
The directive marks a significant shift from prior guidance, which limited medical denials mainly to communicable diseases such as tuberculosis. It grants visa officers greater discretion to determine whether an applicant might require costly medical treatment in the future or depend on US government assistance.
Charles Wheeler, an attorney with the Catholic Legal Immigration Network, said the policy “contradicts the Foreign Affairs Manual,” which traditionally discourages speculative judgments about applicants’ future health needs. “It’s troubling,” Wheeler told KFF Health News, “because these decisions could now be based on ‘what if’ scenarios made by officers who aren’t medical professionals.”
Applicants Must Prove Ability to Pay
The cable also instructs visa officers to evaluate whether applicants possess the financial means to pay for long-term medical care without relying on public assistance. “Does the applicant have adequate financial resources to cover the costs of such care over his entire expected lifespan?” the directive asks.
This expanded scrutiny extends beyond the applicants themselves. Consular officials are directed to consider the health conditions of family members — such as children, elderly parents, or dependents with disabilities — that could affect the applicant’s ability to remain employed or financially self-sufficient.
Immigration Lawyers Warn of Broader Impacts
Immigration attorneys and public health advocates warn that the new policy could lead to widespread visa denials, particularly affecting individuals from low- and middle-income countries. They argue that the rule gives consular officers excessive power to make subjective decisions based on perceived future medical costs rather than objective assessments.
The directive will introduce an unprecedented level of uncertainty and is likely to encourage officers and physicians to estimate “lifetime medical costs”, the calculation of which may largely deviate from standard practices.
Part of a Broader Immigration Crackdown
The expanded medical scrutiny aligns with the Trump administration’s broader efforts to restrict immigration and reduce reliance on public benefits. The “public charge” rule, originally designed to prevent immigrants likely to depend on government aid from entering the US, has been repeatedly revised under Trump to encompass a wider range of factors, including age, health and income.
A State Department official, speaking to Fox News, defended the policy, saying it “ends the era of mass immigration” and ensures that incoming immigrants will not burden the US welfare system.
Critics, however, contend that the measure unfairly penalizes individuals with chronic illnesses, many of whom manage their conditions effectively. They warn that the policy could discourage potential immigrants from seeking medical care or disclosing their health histories out of fear of denial.
As of now, immigrants and non-immigrants alike must still undergo mandatory medical exams by US government-approved physicians. But under the new directive, both doctors and visa officers are expected to probe deeper into applicants’ long-term health prospects — a shift that could redefine how medical fitness is judged in America’s immigration process.