Foreigners with obesity, diabetes, or other chronic health conditions could soon be denied entry to the United States under new guidance issued by the Trump administration, marking one of the most sweeping expansions of medical-based immigration restrictions in modern history.
The directive, sent last week in a State Department cable obtained by KFF Health News, orders U.S. consular officers abroad to consider a wide range of medical conditions, including cardiovascular disease, cancer, diabetes, mental health issues, and obesity, when deciding whether an immigrant could become a “public charge,” or likely dependent on U.S. resources.
The cable instructs visa officers to evaluate whether applicants have the financial means to cover the costs of lifelong treatment and whether their medical conditions could prevent them from maintaining employment. Officers are even told to consider the health of family members, including dependents with disabilities or chronic conditions, when determining visa eligibility.
“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,” the directive states. It specifically calls out obesity as a contributing factor to other costly conditions such as asthma, sleep apnea, and hypertension.
The new policy represents a significant departure from long-standing U.S. immigration practice, which has traditionally limited medical-based inadmissibility to infectious or communicable diseases.
According to existing U.S. Citizenship and Immigration Services (USCIS) guidelines, an applicant can be denied a visa on health grounds if they suffer from communicable diseases such as active tuberculosis, syphilis, leprosy, or gonorrhea, or in some cases, physical or mental disorders linked to harmful behavior.
Chronic, non-contagious conditions like diabetes, heart disease, and obesity have never before received this level of attention as grounds for potential exclusion. In recent years, even restrictions on communicable diseases have loosened. The Obama administration removed HIV from the list of “communicable diseases of public health significance” in 2010.
Historically, health-based exclusions have been used sparingly, and almost always in connection with diseases considered threats to public health. During the early days of the COVID-19 pandemic, Trump temporarily suspended the entry of all aliens who were at elevated risk of infection from the coronavirus, including those in mainland China.
Under Section 212(a)(1)(A) of the Immigration and Nationality Act, the Department of Health and Human Services — not the State Department — defines which conditions qualify as “communicable diseases of public health significance.”
The Trump administration’s new guidance, however, appears to expand that definition by equating potential long-term medical costs with public health risk.
Concerns about both legal and illegal alien usage of public healthcare resources have become more pronounced in recent years.
Last year, Texas Governor Greg Abbott issued an order requiring hospitals to annually report costs for medical care provided to illegal immigrants starting in 2026.