The United States administration has issued a directive instructing consular officials to potentially deny visas to applicants with certain chronic medical conditions—such as diabetes or obesity—if evaluators believe these conditions could render them a "public charge" to the nation.
This guidance, sent via cable from the Department of State to its embassies and consulates and reviewed by KFF Health News, a national newsroom focused on investigative health journalism, increases the emphasis on health status in immigration eligibility. It could primarily impact those seeking permanent residency in the U.S.
While medical examinations have long been part of the application process—including checks for tuberculosis, vaccination status, and histories of drug or alcohol use—experts warn that the new guidelines significantly broaden the range of medical conditions under consideration and give visa officers more discretion.
The cable specifically lists cardiovascular and respiratory diseases, cancer, diabetes, metabolic and neurological disorders, and mental health issues, as well as obesity due to its associated complications (such as asthma, sleep apnea, and hypertension), as factors that may require "costly and prolonged" care.
The directive urges officials to assess whether applicants have sufficient financial resources to cover their healthcare "throughout their lifetime" without relying on public assistance or government-funded institutional care.
It also instructs them to consider the health of dependents (like children or elderly parents) and whether their needs might prevent the applicant from maintaining employment.
Legal analysts point out that this language conflicts with the Foreign Affairs Manual—the State Department's operational guide—which prohibits denying visas based on hypothetical scenarios.
"The cable encourages officials to draw their own conclusions about potential emergencies or future medical expenses," warned Charles Wheeler, senior attorney at the Catholic Legal Immigration Network, questioning whether decision-makers without medical training can predict costs or risks based on biases or conjecture.
Similarly, Sophia Genovese, an immigration attorney at Georgetown University, emphasized that the guidance promotes speculation regarding the cost of care and the employability of applicants based on their medical history.
"If this change is implemented immediately, it will cause numerous issues when individuals attend their consular interviews," she stated.
The document frames this measure as part of the government's strategy to toughen immigration policy through arrests, refugee bans, and reduced admission quotas. It underscores the scale of the issue: around 10% of the global population has diabetes, and cardiovascular diseases are the leading cause of death worldwide, conditions that—according to the cable—could require hundreds of thousands of dollars in lifetime care.
Against this backdrop, health status becomes a central element in consular decisions, beyond routine medical checks and vaccination requirements.
If applied as written, the guidance increases the risk of denial for applicants with chronic illnesses or dependent family members with special needs, even if they meet traditional medical requirements of the immigration process.
The lack of official comments from the Department of State leaves uncertainty about the scope, timeline, and implementation criteria of a change that experts suggest could reshape the entryway to the U.S. for thousands of individuals with common but manageable health conditions.
Implications of U.S. Visa Policies on Health Conditions
What health conditions may affect visa eligibility under the new guidelines?
Conditions such as cardiovascular and respiratory diseases, cancer, diabetes, metabolic and neurological disorders, mental health issues, and obesity are highlighted as factors that could affect visa eligibility due to potential "costly and prolonged" care needs.
How might the new rules impact immigrants seeking permanent residency in the U.S.?
The new guidelines could primarily impact immigrants seeking permanent residency by expanding the list of medical conditions considered in the visa process and giving consular officials more discretion in determining if an applicant might become a "public charge."
Are the new guidelines consistent with existing U.S. immigration policies?
Legal experts argue that the new guidelines conflict with the Foreign Affairs Manual, which prohibits denying visas based on speculative scenarios. The guidelines encourage officials to predict future medical expenses, a practice criticized for lacking medical grounding.