Most countries have regulations for who is allowed to immigrate. Many countries require proof of a certain amount of income. Some require paying into the health care system or some other type of health insurance. About 43 countries require visitors to have private health insurance when they arrive. Before I traveled to Costa Rica in 2021, I had to buy short term health insurance from a government approved provider due to covid fears. I was also not allowed to board my flight home until I had a covid test showing I was not bringing Covid home with me.
It is common to ban travelers with certain diseases from entry. In 1987 the United States classified AIDS as a contagious disease and banned anyone with AIDS from entry into the country. The rule remained in effect until 2008. While critics of this policy called it xenophobic and an unwarranted stigma, it is easy to see why this was a sound policy decision. Not only did health officials not want AIDS to spread further in the U.S., the cost of caring for people who became sick could easily shift to the public. Imagine people who could not afford world class treatment borrowing to buy a plane ticket in hopes they could get public charity care once they arrived.
There are other diseases and conditions that can bar an individual from immigrating to the U.S. Class A Health Conditions include communicable diseases of public health significance, lacking required immunizations, a history of drug addiction and mental or physical conditions that could make you a harm to yourself or others. Any of these can disqualify a would-be immigrant. Class B Health Conditions that can limit entry are permanent, chronic conditions and disabilities that could result in the person becoming indigent. In early November the Trump Administration issued guidance and added to the list of health conditions that can bar immigrants from entry. The following was reported in Kaiser Family Foundation Health News:
Foreigners seeking visas to live in the U.S. might be rejected if they have certain medical conditions, including diabetes or obesity, under a Thursday directive from the Trump administration.
The guidance, issued in a cable the State Department sent to embassy and consular officials and examined by KFF Health News, directs visa officers to deem applicants ineligible to enter the U.S. for several new reasons, including age or the likelihood they might rely on public benefits. The guidance says that such people could become a “public charge” — a potential drain on U.S. resources — because of their health issues or age.
The updated guidance generated outrage among immigrant rights groups and left-of-center pundits. It also was mostly common sense, saying:
“You must consider an applicant’s health,” the cable reads. “Certain medical conditions – including, but not limited to, cardiovascular diseases, respiratory diseases, cancers, diabetes, metabolic diseases, neurological diseases, and mental health conditions – can require hundreds of thousands of dollars’ worth of care.”
The cable also encourages visa officers to consider other conditions, like obesity, which it notes can cause asthma, sleep apnea, and high blood pressure, in their assessment of whether an immigrant could become a public charge and therefore should be denied entry into the U.S.
“All of these can require expensive, long-term care,”
It is difficult to understand why this policy was not already the law of the land going back generations. The guidance also says to evaluate the health of family members, something that I have thought should be done all along.
“Do any of the dependents have disabilities, chronic medical conditions, or other special needs and require care such that the applicant cannot maintain employment?” the cable asks.
Medical care is expensive in the United Stats. It makes sense to take into consideration whether a guest or immigrant will have the means to pay for the care they will undoubtedly need.
Visa officers were also directed to determine if applicants have the means to pay for medical treatment without help from the U.S. government.
“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?” the cable reads.
The United States mostly blocks illegal immigrants from public health programs like Medicaid except under emergencies. Legal immigrants also do not qualify for public assistance for five years. Immigrants are expected to be able to support their own family and care for themselves or not come.
Despite the naysayers and the manufactured outrage, nothing in the guidance appears bad. Of course, every person about to be admitted to the U.S. should be evaluated for whether they will be come a burden on taxpayers.
Read more at KFF Health News: Immigrants With Health Conditions May Be Denied Visas Under New Trump Administration Guidance