A new U.S. directive that broadens how chronic illnesses are evaluated in immigration screenings prior to granting visas is raising concern among immigrant advocates and public health experts, who warn it could unfairly penalize people living with conditions such as diabetes, heart disease and even obesity.
The measure, which immigration attorneys describe as a significant shift in medical vetting, would allow government-approved physicians and consular officials abroad to assess an applicant’s long-term health costs and ability to maintain employment before issuing a visa to come to the U.S.
While U.S. immigration law has long barred entry to individuals with communicable diseases, the new guidance from the State Department extends that scrutiny to chronic, non-contagious conditions that could, in the government’s view, make an applicant more likely to rely on public resources.
According to The Washington Post, the Trump administration has directed visa officers to consider obesity—and other chronic health conditions such as heart disease, cancer and diabetes—as potential reasons to deny foreigners visas to the United States. The Post reported that Secretary of State Marco Rubio informed U.S. consulates and embassies worldwide of the changes in a Nov. 6 cable. The move broadens current medical screening beyond contagious diseases and gives visa officers new grounds to reject applicants, marking the Trump administration’s latest effort to restrict immigration.
Critics fear the change opens the door to subjective decisions and unequal treatment. By linking health status with economic worth, they argue, the policy risks turning manageable medical conditions into barriers to lawful migration.
Currently, all immigrant visa applicants must undergo a medical exam conducted by a physician authorized by a U.S. embassy or consulate. These exams ensure applicants are free of infectious diseases such as tuberculosis or syphilis and verify vaccinations against illnesses including measles, polio and hepatitis B. Applicants must also disclose past drug or alcohol use, mental health conditions and any history of violent behavior.
Under the new directive, however, consular officers and physicians are being instructed to consider not only public health risks but also the potential financial burden a person’s condition might pose in the future. That shift—from preventing disease to assessing “economic fitness”—alarms immigrant advocates, who say it blurs the line between health and social status.
“This policy also fits well with the thinking and way of acting of the Secretary of Health, Mr. Kennedy, regarding his policy and his vision of American society,” said Manuel Vallina Grisanti, a Venezuelan American attorney based in South Florida who specializes in international law and human rights. “Each country and each government is free to impose whatever rules they wish, even if one doesn’t like them, right?”
For Vallina Grisanti, the directive reflects pragmatism rather than discrimination.
“What is being sought, I imagine, with this type of measure, is to minimize costs for American health agencies and, therefore, for taxpayers—what might have to be paid in the future for medical services for people suffering from certain illnesses,” he said. “This is something that not only the U.S. wants to implement, but also other European countries are doing the same.”
He argues that such steps fall within a government’s legitimate right to regulate immigration according to its own priorities.
Others, however, see something more troubling in the government’s move. Helene Villalonga, a Venezuelan activist and community leader in South Florida, believes the measure marks another turn toward exclusion and stigma.
“They’re putting these restrictions in place, I think, so that in the end immigrants don’t become a burden on the country—at least that’s how I understood it,” she said. “But it seems discriminatory to me, like everything the Donald Trump administration has been doing.”
For Villalonga, the issue isn’t just about policy but about identity—about who belongs and who doesn’t. “The profile he’s been promoting is one of discrimination, making people feel like they’re first-, second-, or third-class citizens,” she said. “That’s how I feel, and that’s how he’s made everyone in his government feel.”
She fears the directive sends a chilling message to immigrants and would-be immigrants alike. “At least as a Venezuelan, I feel discriminated against—but now it’s everyone,” she said. “Now it’s the Venezuelan, the sick person, the overweight person, the diabetic—it’s everyone in general. There’s a type of American the government ‘marries,’ so to speak, and a type of person the government doesn’t want any relationship with. And that’s what’s being felt today.”
Villalonga also worries the new approach could affect people already living in the United States who manage chronic conditions.
“Imagine the person who’s already in the country and has that medical condition,” she said. “In some way, you’re planting fear in that person, because if they see the government targeting visa or residency applicants with such conditions, they’ll think, ‘What’s going to happen to me? At some point, they’re going to come after me too.’”
Immigration lawyers note that while the directive has not yet been formally published, it appears to revive elements of the “public charge” rule—a controversial policy expanded under the Trump administration. That rule allowed officials to deny green cards or visas to individuals deemed likely to rely on government benefits such as Medicaid or food assistance. It prompted widespread outcry and multiple court challenges before being rolled back by the Biden administration in 2022.
Under the new guidance, chronic illnesses could become the next battleground in determining who qualifies as “self-sufficient.” Public health experts warn that such a shift could discourage applicants from seeking medical care or being fully transparent about their health—potentially worsening outcomes for individuals and communities alike.
To Vallina Grisanti, however, the measure is part of a broader global recalibration of immigration and welfare policy. “There are, in fact, many changes—many changes,” he said. “But in principle, each government has the right and the duty to handle integration in whatever way it believes is best for its country.”
For advocates like Villalonga, that reasoning misses the human cost. “It seems discriminatory to me,” she said. “There’s a type of American the government wants—and a type it doesn’t.”
By ANTONIO MARIA DELGADO/Miami Herald