U.S. immigration officers can deny visas based on medical conditions. It's raising concerns

It’s never been easy to get a visa to live in the United States, but the Trump administration is making the bar even higher.

The administration just released new guidelines directing the State Department to deny visas based on age or certain health conditions. So, if you have diabetes, obesity or cardiovascular disease, you could be denied. Basically, if you might need to rely on public benefits in the future, you could be out of luck.

It’s all raising concerns about untrained immigration officers making unfounded predictions about a person’s future health.

Joining The Show to put this news into context is Melissa del Bosque, longtime border reporter and co-founder of the Substack "The Border Chronicle."

Eugenio del Bosque

Full conversation

LAUREN GILGER: Good morning, Melissa.

MELISSA DEL BOSQUE: Good morning.

GILGER: So it's always been part of the visa application process, right, to, to, like, assess someone's health. Like, what's changed here, really?

DEL BOSQUE: Well, this is giving visa officers, you know, at the U.S. Embassies this ability to deny somebody a visa just based on whether, you know, they're overweight, whether they have a heart condition or diabetes.

I mean, you know, visa officers are not physicians. They're employees of, you know, the State Department. So it's quite an expansion of the powers that these visa officers are being given under this new directive.

GILGER: So let's talk a little bit about where this health information might go. Who has access to it? Like, are there concerns about how they collect this data?

DEL BOSQUE: Yes, and I think there's a lot of confusion around the directive because it appears to apply to all visa applicants. But I think, you know, immigration legal experts are saying this will probably mostly impact people who are seeking, like, long-term permanent residency in the U.S.

They're already required to go through a medical examination and fill out forms and provide quite a lot of information about, you know, communicable diseases, their drug and alcohol use, mental health conditions. Quite, quite a bit. So this seems to be a much higher bar where just the visa officers themselves are making a determination, possibly before it even goes to a physician.

GILGER: So the whole idea here, and the State Department was pretty, you know, is, is pretty straightforward in this guidance that they got, right, that, that they might not want to accept immigrants who could be basically a drain on U.S. resources in the future.

I mean, I wonder, like, what information should we use or do we already use to decide who gets to be here and who doesn't?

DEL BOSQUE: Well, I think the, the current standards, so immigrants coming to the U.S. since the late 1800s have always been subject to health checks and so forth. But this, this new directive goes against the State Department's own foreign affairs manual, which says that, you know, visa officers can't reject people just based on what-if scenarios.

You know, if you're overweight, could that in the future cost the U.S. government money? These are really like, you know, what-if scenarios. They're not really grounded in any type of actual data. Yeah.

GILGER: So I want to talk about the broader picture here, because this is not the only thing that's happened recently that's come out of the Trump administration that restricts legal immigration, right. Like a lot of what we talk about right now in the news in terms of immigration is, is a crackdown on illegal immigration.

But this is, this is making it much harder to legally it migrate here. What other policies has the Trump administration put in place to make this kind of legal immigration more difficult?

DEL BOSQUE: Right. Yeah. I mean, this is really part of a larger plan as, as you said, to restrict legal immigration to the country. Just recently, the administration announced that would cut the number of refugees that it'll admit to the U.S. to the lowest number ever since the U.S. refugee program was established in 1980.

So that's just 7,500 refugees allowed to be admitted this in 2026. And for reference, in 2025, the refugee cap was set at 125,000. So it's a, it's a huge reduction in the amount of refugees that the country is going to allow in.

GILGER: There are also charges now, much higher charges for people coming in on H-1B visas. Right. And of course, the Trump administration has introduced gold card, which is basically, you know, a quick path to citizenship or immigration status for people who can pay the government a lot of money, right?

DEL BOSQUE: Yeah. A golden, a golden visa, yes. So, you know, if you have millions of dollars, then you can get a pretty quick citizenship process, become a US citizen.

The H-B1 visas, I think, is going to have a huge impact on the U.S. and Arizona, especially because it affects physicians. About 25% of our physicians in the U.S. are foreign-born, and they come to train here and then they become physicians here and they serve rural, underserved areas.

That's about one in four of the physicians we have here in Arizona. So it's going to really impact, you know, rural areas. And so that's $100,000 for a visa to bring in a foreign doctor. And that's up from a price of, $2,000 to $5,000 is what it used to be. So these rural hospitals and health care facilities are not going to be able to afford to pay that kind of money.

GILGER: Let me ask you lastly, Melissa, just what you think the long term implications of this kind of crackdown could be like if we're looking at restricting both kinds of immigration here.

What, what does this change about what it means to, to live in this country, to get into this country to be an American?

DEL BOSQUE: Well, I mean, you know, our universities rely on foreign scholars and researchers to come in. I think we, we have a reputation in this country as being innovative, of being collaborative. We're not going to, universities are not going to be able to afford to bring in those, those scholars and researchers because of the $100,000 charge.

Also with physicians, it's really going to hugely impact us, especially with general practitioners, family physicians, which are already really difficult to find among the U.S.-born population.

So this is going to continue to ripple, I think, throughout our country for the next several years as we just see fewer research studies, we see fewer physicians, fewer nurses. You know, this could impact us for many years to come.