Immigrants applying for U.S. visas could now be denied entry if they suffer from common health conditions such as diabetes, obesity, or heart disease, under a controversial new guidance issued by the Trump administration.
The internal State Department memo, first reported by KFF Health News and later confirmed by ABC News, instructs embassy and consular officials worldwide to consider chronic illnesses, age, and the potential cost of future medical care as factors in determining whether an applicant might become a “public charge” — someone deemed likely to rely on U.S. public assistance.
While assessing an applicant’s health has long been part of the immigration process, experts say this new directive marks a dramatic expansion of what conditions can disqualify a person from entering the United States.
“You can now get your immigrant visa or green card denied at the embassy for being obese,” said immigration attorney Saman Movassaghi Gonzalez, reacting to the memo on social media. “Chronic health conditions like obesity or diabetes can be seen as a burden to the U.S. government, even if you’re financially self-sufficient.”
A Broader Crackdown on Immigration
The new guidance is the latest in a string of aggressive immigration measures pursued under Donald Trump’s administration, which has vowed to tighten restrictions on who can enter or stay in the country.
It follows earlier crackdowns, including the revival of mass deportation operations, restrictions on refugee admissions, and proposals to reinstate a stricter version of the “public charge” rule that was previously struck down in federal courts.
Immigration advocates have called the move a “backdoor health ban”, warning that it could disproportionately affect applicants from developing countries where rates of chronic illness are rising due to global shifts in diet and lifestyle.
“This policy effectively punishes people for being sick — or even for being human,” said Sophia Genovese, an immigration lawyer at Georgetown University. “Having diabetes or high blood pressure shouldn’t make you unworthy of a visa.”
The Memo’s Scope and Criteria
The State Department cable, distributed to consulates and embassies, explicitly lists cardiovascular disease, respiratory illness, cancer, metabolic disorders, neurological diseases, and mental health conditions as examples of potentially disqualifying factors.
It also advises visa officers to weigh obesity as a condition that could lead to costly health complications such as asthma, sleep apnea, and hypertension.
“Does the applicant have adequate financial resources to cover the costs of such care over his entire expected lifespan?” the cable asks.
Critics say this question grants consular officers unchecked discretion to make medical judgments they aren’t trained to make.
“They are not doctors,” said Charles Wheeler of the Catholic Legal Immigration Network. “They’re now being told to predict who might develop expensive medical problems — based on nothing more than their own assumptions.”
Human Impact and Fears of Discrimination
Globally, more than 10% of adults live with diabetes, while obesity affects nearly one in eight people, according to the World Health Organization. Many applicants — including those who already have jobs, private insurance, or family sponsors in the U.S. — fear being unfairly branded as financial risks.
The directive also extends to family members. Consular officers are instructed to consider whether an applicant’s dependents — such as elderly parents or children with disabilities — could affect their employability or lead to future medical costs.
Immigrant advocates warn that such broad discretion could open the door to bias and discrimination, especially against older applicants, low-income families, and people from African, Caribbean, or Latin American nations where non-communicable diseases are more prevalent.
“This policy paints with an unscientific brush,” said one legal aid volunteer in New York. “It treats ordinary medical conditions as moral failings or financial threats.”
A Shift From Compassion to Cost
Until now, medical screenings for visa applicants primarily focused on communicable diseases like tuberculosis or HIV and verifying vaccination records. The new rule reframes chronic illness as an economic liability, rather than a matter of public health.
For immigration attorney Gonzalez, the policy represents a philosophical shift in how America views immigrants:
“The message is clear — you’re welcome only if you’re young, healthy, and profitable,” he said.
Unanswered Questions
As of press time, the State Department had not publicly commented on the memo. Immigration attorneys say they are already fielding questions from worried clients preparing for consular interviews abroad.
Some expect lawsuits challenging the policy on constitutional and humanitarian grounds. Others fear the impact will be immediate and quiet — a pattern of rejections with little transparency or recourse.
For now, the memo’s release underscores how far-reaching the Trump administration’s second-term immigration agenda has become — one that fuses fiscal conservatism with nationalist rhetoric, and in doing so, raises a moral question:
Should health — something few can entirely control — determine one’s right to seek a better life?
This story will be updated as more details emerge from the State Department and immigrant advocacy groups.
