Under a new Trump administration directive from the State Department to embassy and consular staff, and examined by KFF Health News, visa officers are to deny entry to applicants for a variety of new reasons, including age or the possibility of relying on public services.
It states that such individuals may become a ‘public charge’ — a potential drain on US resources — due to health concerns or advanced age. The new criteria require that immigrants’ health be prioritised throughout the application process.
Experts said the new guidelines significantly broaden the list of medical conditions to be taken into consideration and give visa officers more authority to make decisions about immigration based on an applicant’s health status, even though evaluating potential immigrants’ health has long been a part of the visa application process, including screening for communicable diseases like tuberculosis and obtaining vaccine history.
According to the cable, “You must consider an applicant’s health. Certain medical conditions – including, but not limited to, cardiovascular diseases, respiratory diseases, cancers, diabetes, metabolic diseases, neurological diseases, and mental health conditions – can require hundreds of thousands of dollars’ worth of care.”
It also urged visa officials to examine other problems, such as obesity, which can cause asthma, sleep apnea, and high blood pressure, when determining whether an immigrant may become a public charge and so be denied entrance into the country. “All of these can require expensive, long-term care,” it added.
Visa officers were also instructed to examine whether applicants have the resources to pay for medical care without assistance from the US government. “Does the applicant have adequate financial resources to cover the costs of such care over his entire expected lifespan without seeking public cash assistance or long-term institutionalisation at government expense?” the cable stated.
According to Charles Wheeler, a senior attorney for the Catholic Legal Immigration Network, a non-profit legal aid organisation, the guidelines apply to nearly all applicants but are most likely to be applied mainly in circumstances where persons want to permanently reside in the country.
It also directs officers to develop “their own thoughts about what could lead to some sort of medical emergency or sort of medical costs in the future,” Wheeler added.
It also instructs visa officials to evaluate the health of family members, such as children and elderly parents. “Do any of the dependents have disabilities, chronic medical conditions, or other special needs and require care such that the applicant cannot maintain employment?” the cable reads.
Immigrants already have a medical check-up performed by a physician recognised by the US embassy. They are screened for communicable diseases such as tuberculosis and asked to fill out a questionnaire revealing any history of drug or alcohol use, mental health issues, or violence.
According to Sophia Genovese, an immigration lawyer at Georgetown University, the new guidance takes a step further, emphasising the importance of addressing chronic conditions. She also pointed out that the directive’s language invites officers and doctors who assess those seeking to immigrate to speculate on the expense of applicants’ medical care and their potential to find work in the country.
