US to tighten visas, green cards over health risks
The US has issued new visa rules allowing officials to deny entry or residency to foreigners with conditions like diabetes, obesity, or heart disease, citing potential healthcare burdens.
Washington: In a controversial new move, the Trump administration has issued a directive tightening the medical scrutiny of foreign nationals applying for US visas and permanent residency, raising concerns that individuals with certain health conditions — including diabetes, obesity, and heart disease — could face denial of entry or residency.
The new guidelines, sent by the US State Department to American embassies and consulates worldwide, instruct visa officers to flag applicants whose medical conditions could result in high healthcare costs or long-term dependence on public resources. According to a report by KFF Health News, the cable emphasizes that applicants with chronic illnesses could be deemed a “public charge,” meaning they might become a financial burden on the US government due to their potential need for extensive medical care.
Officials familiar with the directive say it applies to all categories of visa applicants, but the focus is primarily on those seeking permanent residency or Green Cards. A senior immigration attorney told KFF Health News that the policy represents a significant expansion of the “public charge” rule, which historically centered on financial dependency rather than health status.
“It effectively allows consular officers to deny visas based on medical predictions — not actual dependence on government assistance.”
The State Department cable reportedly lists a wide range of health conditions that could trigger scrutiny, including cardiovascular diseases, cancers, metabolic and neurological disorders, diabetes, mental health conditions, and obesity. Officers are instructed to assess the potential future costs of treatment, sometimes amounting to “hundreds of thousands of dollars’ worth of care,” when evaluating an applicant’s eligibility.
The guidance specifically highlights obesity as a contributing factor to other medical risks such as asthma, sleep apnoea, and high blood pressure, suggesting that these could compound an individual’s potential burden on the healthcare system. Consular officers are also encouraged to take an applicant’s age into account, as older immigrants are more likely to require ongoing medical attention.
Critics say the new approach represents a sharp departure from past US immigration norms, where medical assessments primarily focused on communicable diseases like tuberculosis or conditions that posed a direct threat to public health. Instead, the Trump administration’s directive expands the criteria to include chronic, non-contagious illnesses that millions of people manage with medication and lifestyle changes.
Public health experts warn that the policy could have far-reaching humanitarian consequences. “Conditions like diabetes and hypertension are global health challenges,” said Dr. Melissa Rowe, a policy analyst at the Johns Hopkins Center for Health Equity. “To use them as grounds for exclusion sends a troubling message — that people with manageable conditions are somehow unworthy of contributing to society.”
Advocates for immigrants also argue that the directive discriminates against individuals from countries with high rates of chronic disease, particularly in South Asia, Latin America, and Africa, where conditions such as diabetes and heart disease are on the rise. “This will disproportionately affect hardworking, skilled immigrants who already face barriers to entry,” said Aliyah Khan, director of the National Immigration Justice Alliance.
Supporters of the new rules, however, contend that the United States has a right to protect its healthcare system and taxpayers from potential financial strain. “The policy ensures that immigrants coming to the country can sustain themselves and not depend on public funds,” said a senior administration official defending the move.
The latest directive is part of a broader Trump-era effort to tighten immigration policies under the banner of economic self-sufficiency. Earlier policies had already expanded the “public charge” definition to include reliance on food stamps, housing aid, or Medicaid. The addition of chronic health conditions to the list marks yet another restrictive turn.
As embassies begin implementing the guidelines, immigration lawyers are preparing legal challenges, arguing that the policy violates anti-discrimination laws and international human rights standards. For now, the message from Washington is clear — under the Trump administration’s new vision of immigration, even one’s health could determine their chance at the American dream.