US May Deny Visas to Immigrants with Obesity, Cancer or Diabetes Under New State Department Rules

Foreigners seeking to live in the United States may be denied visas if they have common health conditions including obesity, diabetes or heart disease under new guidance issued by the Trump administration on Thursday. The directive, sent via cable to US embassies and consular officials worldwide, significantly expands the list of medical conditions that visa officers can use to determine whether an applicant might become a 'public charge', a potential drain on American resources.

The guidance instructs visa officers to consider conditions 'including, but not limited to, cardiovascular diseases, respiratory diseases, cancers, diabetes, metabolic diseases, neurological diseases, and mental health conditions', noting that such conditions 'can require hundreds of thousands of dollars' worth of care'. The cable also singles out obesity, stating it can cause asthma, sleep apnoea and high blood pressure that 'can require expensive, long-term care'.

Expanded Powers, Limited Training

Whilst health screening has long been part of the visa application process, the new guidelines represent a dramatic expansion of power for consular officers, who lack medical training yet are now expected to make projections about future healthcare costs. The cable's language appears to contradict the State Department's own Foreign Affairs Manual, which prohibits rejecting applications based on 'what if' scenarios.

The scope of the policy is sweeping. Visa officers are now directed to assess whether applicants have 'adequate financial resources to cover the costs of such care over his entire expected lifespan without seeking public cash assistance or long-term institutionalisation at government expense'. The guidance also extends scrutiny to family members, asking whether dependents have 'disabilities, chronic medical conditions, or other special needs' that might prevent the applicant from maintaining employment.

A Policy Affecting Millions

The policy targets conditions that affect billions worldwide. About 10 per cent of the global population has diabetes, according to the World Health Organisation, whilst cardiovascular diseases are the world's leading killer. In the United States alone, 40 per cent of Americans are obese, according to the Centers for Disease Control and Prevention, raising questions about the consistency of denying entry to immigrants with the same conditions that affect a large proportion of the existing population.

Officers are instructed to develop their own assessments about what could lead to medical emergencies or future medical costs, despite having no medical training or experience in healthcare cost projections. This gives individual consular officials unprecedented discretion to make life-altering decisions based on speculation about health conditions that may or may not require expensive treatment.

Immigrants already undergo a medical exam by a physician who has been approved by a US embassy. They are screened for communicable diseases like tuberculosis and required to disclose any history of drug or alcohol use, mental health conditions or violence. They must also have vaccinations against infectious diseases including measles, polio and hepatitis B.

The new guidance goes considerably further, emphasising that chronic diseases should be considered and encouraging visa officers and examining physicians to speculate on the cost of applicants' medical care and their ability to obtain employment in the United States. Taking into consideration an applicant's diabetic history or heart health history represents a significant expansion of the traditional screening process.

The expanded criteria appear likely to create significant uncertainty and potential for discrimination in the visa application process. The subjective nature of projecting future healthcare costs and employment capacity based on current health conditions leaves considerable room for inconsistent application of the policy across different consular posts worldwide.

Echoes of the 'Public Charge' Rule

The directive appears to resurrect the 'public charge' rule from Trump's first administration, which sought to deny green cards to immigrants who received designated public benefits for more than 12 months within any three-year period. That rule faced legal challenges and was eventually withdrawn by the Biden administration.

The guidance applies to immigrant visa applicants seeking permanent residency, not temporary visitors on tourist visas. It represents the latest in a series of aggressive immigration restrictions from the Trump administration, which has undertaken daily mass arrests, banned refugees from certain countries and drastically reduced the total number of refugees permitted into the United States.