A fresh wave of controversy has hit U.S. immigration policy after the State Department issued a directive allowing visa denials based on chronic health conditions. Under new instructions reportedly authorised by Secretary of State Marco Rubio, illnesses such as obesity, cancer, diabetes, and a range of long-term disorders may now be treated as red flags during visa evaluations.
The move, revealed through a cable obtained by Politico, expands the long-standing “public charge” rule. Traditionally, this rule assessed whether an immigrant might rely on government assistance. It was mostly applied to financial stability and the risk of becoming a burden on the welfare system. Medical screenings previously focused on contagious diseases, such as tuberculosis or polio.
That approach has now shifted.
The cable states that diplomats must consider whether an applicant’s health could lead to “hundreds of thousands of dollars’ worth of care,” adding that chronic illnesses — from cardiovascular to neurological and mental health conditions — could place a heavy financial strain on U.S. taxpayers.
Critics say this opens a wide door for subjective decisions. Speaking to KFF Health News, Georgetown University immigration attorney Sophia Genovese warned that the change places unrealistic pressure on officials who are not medical professionals.
She noted that evaluating complex medical histories is already a sensitive process: “Taking into consideration one’s diabetic history or heart health history — that’s quite expansive… If this change is going to happen immediately, it’s obviously going to cause a myriad of issues when people are going into their consular interviews.”
The policy update comes at a time when the U.S. healthcare system is facing its own crises. A 2024 report by The Commonwealth Fund underscored an uncomfortable reality: despite spending more on healthcare than any other wealthy nation, Americans are “sicker, die younger, and struggle to afford essential care.”
The expanded visa rule appears to merge immigration concerns with the country’s ongoing struggles over medical costs and access to treatment — and its consequences could ripple across families, workers, and global mobility for years to come.
