Foreigners seeking visas to live in the United States may be denied if they have certain medical conditions, including diabetes or obesity, according to a Trump administration directive on Thursday.
The guidance, published in a cable the State Department sent to embassy and consulate officials and reviewed by KFF Health News, directs visa officers to consider applicants ineligible for entry into the U.S. for several new reasons, including age or the likelihood that they may qualify for government benefits. The guidance says such people could become a “public burden”—a potential drain on U.S. resources—due to health problems or age.
While health assessments of potential immigrants have been part of the visa application process for years, including screening for infectious diseases such as tuberculosis and collecting vaccination histories, experts say the new guidelines significantly expand the list of medical conditions that need to be considered and give visa officers more power to make immigration decisions based on the applicant's health status.
The directive is part of the Trump administration's divisive and aggressive campaign to deport immigrants living in the U.S. without authorization and discourage others from immigrating to the country. The White House crusade to drive out immigrants included daily mass arrests, bans on refugees from some countries and plans strictly limit the total number allowed to enter the USA
The new guidelines require immigrants' health to be a central focus during the application process. The guidance applies to nearly all visa applicants, but will likely be used only in cases where people seek permanent U.S. residency, he said. Charles Wheelersenior attorney for the Catholic Legal Immigration Network, a nonprofit legal aid group.
“You must consider the health of the applicant,” the cable reads. “Certain medical conditions, including but not limited to cardiovascular disease, respiratory disease, cancer, diabetes, metabolic disease, neurological disease and mental illness, can require hundreds of thousands of dollars in treatment.”
ABOUT 10% of the world's population has diabetes. Cardiovascular disease is also common; they are of the globe main killer.
The cable also urges visa officers to consider other conditions such as obesity, which it notes can cause asthma, sleep apnea and high blood pressure, when assessing whether an immigrant may become a public charge and therefore be denied entry into the United States.
“All of this may require costly and long-term care,” the cable said. State Department officials did not immediately respond to requests for comment on the cable.
Visa officers were also tasked with determining whether applicants have the means to pay for medical treatment without assistance from the U.S. government.
“Does the applicant have sufficient financial resources to cover the cost of such care for the entire life expectancy without seeking government cash assistance or long-term institutionalization at government expense?” The cable is reading.
The cable's wording contradicts the Foreign Affairs Manual, the State Department's own handbook, which says visa officers cannot deny an application based on “what-if” scenarios, Wheeler said.
The guidance instructs visa officers to develop “their own thoughts about what could lead to medical emergencies or medical expenses in the future,” he said. “This is concerning because they are not medically trained, they have no experience in the field, and they should not make predictions based on their own personal knowledge or bias.”
The guidelines also instruct visa officers to consider the health status of family members, including children or elderly parents.
“Do any dependents have a disability, chronic illness or other special needs or require care that would prevent the applicant from maintaining employment?” – asks the cable.
Immigrants already undergo medical examinations by a doctor approved by the US Embassy.
They are screened for infectious diseases such as tuberculosis and asked to undergo fill out the form in which they are asked to disclose any history of drug or alcohol use, mental illness or violence. They also need to receive a series of vaccinations to protect against infectious diseases like measles, polio and hepatitis B.
But the new guidance goes further, emphasizing that chronic illnesses should be taken into account, said Sofia Genovese, an immigration lawyer at Georgetown University. She also noted that the directive's language encourages visa officers and doctors who evaluate people seeking to immigrate to think about the cost of applicants' health care and their ability to obtain work in the U.S. given their medical history.
“Taking into account a history of diabetes or a history of heart disease, it's quite expensive,” Genovese said. “There's already a degree of that assessment, but it's not as extensive as thinking, 'What if someone goes into diabetic shock?' If this change happens immediately, it will obviously cause a lot of problems when people go through consulate interviews.”
