The United States has quietly rolled out one of the most sweeping shifts in its immigration policy: health status is now a potential deal-breaker for visa hopefuls. Under a recently-issued directive from the U.S. Department of State, applicants for U.S. visas may be denied if their medical condition — including chronic issues like obesity, diabetes, heart disease or other serious disorders — suggests they might become a “public charge“, KFF Health News has reported.For decades, health-screening for visa applicants was largely limited to communicable diseases and vaccination proof. But the new guidance rewrites that script. The memo directs consular officers to assess not just infectious-disease risk but lifetime medical cost projections and whether a visa applicant’s health might mean heavy dependence on U.S. public resources. “While assessing the health of potential immigrants has been part of the visa application process for years, including screening for communicable diseases like tuberculosis and obtaining vaccine history, experts said the new guidelines greatly expand the list of medical conditions to be considered and give visa officers more power to make decisions about immigration based on an applicant’s health status,” the media outlet reported.

People applying to move to the U.S. already have to go through a medical checkup done by a doctor approved by the U.S. embassy. During this exam, they’re tested for contagious illnesses such as tuberculosis and asked to fill out a form about their health history — including any past drug or alcohol use, mental health issues, or violent behavior. They also need to show proof of several vaccines, like those for measles, polio, and hepatitis B, to make sure they’re protected against infectious diseases.The list of flagged conditions is broad: cardiovascular disease, respiratory illnesses, cancers, metabolic and neurological disorders, mental-health conditions. And yes — it explicitly mentions obesity as a red flag, citing its links to asthma, sleep apnea, hypertension and other costly complications. At the heart of this change is a simple question: will this person, because of their health, become a burden on the U.S. system? The directive spells it plainly. It asks: “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 institutionalization at government expense?”

Who this affects

In practice, the guidance is expected to hit those seeking immigrant visas—those hoping to settle in the U.S. permanently—more than short-term tourists or temporary workers. But the ripple effects might reach farther: family-members, dependents and even those applying for student or work visas might feel the squeeze if their associated health profiles or financial backing raise questions.