Trump administration says immigrants may be denied visas for health reasons : NPR

The Trump administration is asking immigration officials to consider certain chronic health conditions like diabetes before deciding whether to issue visas to immigrants.

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Foreigners seeking a visa to live in the United States could be turned away if they have certain health conditions, including diabetes or obesity, under a directive issued last week by the Trump administration.

The guidance, issued in a cable the State Department sent to embassies and consular officials and reviewed by KFF Health News, directs visa officers to consider applicants ineligible to enter the United States for several new reasons, including age or likelihood of relying on public benefits.

The guidance says these people could become a “public charge” — a potential drain on U.S. resources — because of their health conditions or age.

Although assessing the health of potential immigrants has been part of the visa application process for years, including screening for communicable diseases such as tuberculosis and obtaining immunization history, experts said the new guidelines significantly expand the list of medical issues to consider and give visa officers more power to make immigration decisions based on the applicant’s health status.

The directive is part of the Trump administration’s aggressive and confrontational campaign to deport immigrants living unauthorized in the United States and deter others from immigrating to the country. The White House’s crusade to drive out immigrants has resulted in daily mass arrests, bans on refugees from certain countries and plans to severely restrict the overall number allowed into the United States.

The new guidelines require that immigrants’ health be a priority in the application process. These guidelines apply to almost all visa applicants, but will likely only be used in cases where people seek permanent residence in the United States, said Charles Wheeler, senior attorney for the Catholic Legal Immigration Network, a nonprofit legal aid group.

“You must consider the health of the candidate,” the cable read. “Certain medical conditions – including, but not limited to, cardiovascular disease, respiratory disease, cancers, diabetes, metabolic diseases, neurological diseases and mental health issues – can require care worth hundreds of thousands of dollars. »

About 10% of the world’s population suffers from diabetes. Cardiovascular diseases are also common; they are the leading killers in the world.

The cable also encourages visa officers to consider other conditions, such as obesity, which it says can cause asthma, sleep apnea and high blood pressure, in their assessment of whether an immigrant might become a public charge and therefore should be denied entry to the United States.

“All of this can require expensive, long-term care,” the cable reads. State Department spokespeople did not immediately respond to a request for comment on the cable.

Visa officers have also been instructed to determine whether applicants can afford medical care without assistance from the U.S. government.

“Does the applicant have sufficient financial resources to cover the costs of this care over his or her expected lifespan without reliance on public financial assistance or long-term institutionalization at government expense?” reads the cable.

The cable’s language appears at odds with the Foreign Affairs Manual, the State Department’s own manual, which says visa officers cannot reject an application based on “what if” scenarios, Wheeler said.

The guidelines ask visa officers to develop “their own thoughts about what might lead to some sort of medical emergency or medical expense in the future,” he said. “It’s troubling because they don’t have medical training, they don’t have any experience in this field and they should not make projections based on their own personal knowledge or biases.”

The guidelines also ask visa officers to consider the health of family members, including children or older relatives.

“Does any of the dependents have a disability, chronic health condition, or other special needs and require such care that the applicant cannot maintain employment?” » » asks the cable.

Immigrants already undergo a medical examination by a physician approved by a U.S. embassy.

They are screened for communicable diseases, such as tuberculosis, and asked to fill out a form asking them to disclose any history of drug or alcohol use, mental health problems or violence. They must also receive a number of vaccines to protect against infectious diseases such as measles, polio and hepatitis B.

But the new guidelines go further, emphasizing that chronic illnesses need to be considered, said Sophia Genovese, an immigration attorney at Georgetown University. She also pointed out that the directive’s language encourages visa officers and doctors who examine people seeking to immigrate to speculate on the cost of applicants’ medical care and their ability to find employment in the United States, given their medical history.

“Taking into consideration a person’s history of diabetes or heart health, it’s pretty broad,” Genovese said. “There is already some degree of this assessment, but not as broad as the opinion on ‘What if someone goes into diabetic shock?’ “If this change is to happen immediately, it’s obviously going to cause a myriad of problems when people show up for their consular interviews. »

KFF Health News is a national newsroom that produces in-depth journalism on health issues and is one of the major operating programs of KFF.