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The United States administration issued a directive instructing consular officials to deny visas to applicants with certain chronic medical conditions —including diabetes or obesity—if, in the opinion of the evaluators, these conditions could render them a “public charge” for the country.
The guideline, sent via cable from the State Department to embassies and consulates and reviewed by KFF Health News, a national newsroom that produces investigative journalism on health issues, increases the significance of health status in immigration eligibility and could particularly affect those seeking permanent residency in the U.S.
Although medical examinations have been part of the process for years— including screening for tuberculosis, reviewing vaccination records, and checking for drug or alcohol use—experts warn that the new guidelines significantly broaden the range of diseases to consider and give visa officers more discretion.
The report explicitly mentions cardiovascular and respiratory diseases, cancer, diabetes, metabolic and neurological disorders, and mental health issues, as well as obesity due to its associated complications (asthma, sleep apnea, hypertension), as factors that may require “costly and prolonged” care.
The instruction requests to determine whether the applicant has sufficient financial resources to cover the care "for the entirety of their lifespan" without resorting to public assistance or government-funded institutionalization.
It also guides to assess the health of dependents (children or elderly parents) and whether their needs could prevent the applicant from maintaining employment.
For legal analysts, this language conflicts with the Foreign Affairs Manual—the operational manual of the State Department itself—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, lead attorney for the Catholic Immigration Legal Network, questioning whether decision-makers without medical training should project costs or risks based on bias or conjecture.
In the same vein, Sophia Genovese, an immigration attorney from Georgetown University, emphasized that the guidance leads to speculation about the cost of care and the employability of applicants based on their medical history.
“If this change is implemented immediately, it will cause a multitude of problems when people go to their consular interviews,” he said.
The document contextualizes the measure within the government's strategy to tighten immigration policy through arrests, bans on refugees, and a reduction in admission quotas, and emphasizes the magnitude of the phenomenon: around 10% of the global population suffers from diabetes, and cardiovascular diseases are the leading cause of death worldwide, pathologies that—according to the report—may involve hundreds of thousands of dollars in medical care over a lifetime.
Against this backdrop, health status becomes a central element in the consular decision, going beyond the usual clinical checks and vaccination requirements.
If implemented as written, the guide raises the risk of denial for applicants with chronic illnesses or with dependent family members with special needs, even when they meet the traditional medical requirements of the migration process.
The absence of official comments from the State Department at the close of the report fuels uncertainty regarding the scope, timeline, and criteria for implementing a change that, according to experts, could reshape the entryway to the U.S. for thousands of individuals with common but manageable health conditions.
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