Yves here. The new Trump Administraton policy on visa issuance, that of making certain conditions like obesity and diabetes a no-go for longer-term visa issuance, substantively is not as out of line with practices in much of the rest of the world as one might think. But they address the issue of not having foreigners unduly burden the health system with bills that won’t be paid not by medical tests but via requiring proof of a certain level of income and/or medical insuarnce. Admittedly, many countries do require medical exams for longer-term visas, but they are typically to screen out communicable diseases like TB and HIV. But as far as I can tell, the Trump Administration focus on diabetes and obesity is an big outlier.
Even for mere tourist visas, more and more countries are requiring travel insurance. From Forbes in October
Which countries require travel insurance, and why? And how do you find a policy that will be approved?
Argentina …
Europe’s Schengen Area also requires insurance. All 29 countries in Europe that belong to the Schengen Area require visa applicants to carry about $35,000 in medical coverage, including emergency hospitalization and repatriation. That’s not a suggestion buried in fine print. It’s a hard requirement.
“All 29 countries of the Schengen Area require all Schengen visa applicants to take out travel insurance, but not just any policy will do,” explains Clément Goubon, chief marketing officer of Insurte. “The policy they choose has to meet specific criteria set by the Schengen Zone.”
Cuba ….
Ecuador and the Galápagos Islands…
Thailand, Turkey, the UAE, and Russia …
All told, 23 countries plus Europe’s Schengen region, now require travel insurance, according to Insubuy. “And many more require some sort of coverage for certain visitors,” adds spokesman Mike Farren.
Bottom line: There’s an excellent chance that if you’re crossing a border, you’ll need travel insurance. And unlike the last period in when mandatory insurance was required, this one is likely to stick, say experts.
Having said that, the Trump Administration using obesity and diabetest as screening criteria has racist undertones. Mexicans in particular come from what is called a metabolically thrify population, the result of periods of starvation in its gene pool. That means they have a greater propensity to diabetes even at normal body weights than Caucasians, and are also very susceptible to overweight and obesity. From a 2005 study, but the basic issues remain the same:
Mexican Americans are one of the fattest groups in what is one of the fattest nations on earth. Three out of four Mexican American adults (aged >20 years) were either overweight or obese at the end of the 20th century…
Diabetes is a serious public health problem among Mexicans and Mexican Americans. Diabetes was found in 8.1% of Mexican adults in 2000 (11) compared with 13.1% and 14.5% of Mexican American men and women in 1988–94 . In the United States, adults of Mexican origin, particularly men, had higher rates of prevalence of diabetes than non-Hispanic whites or blacks, as well as a greater degree of impaired fasting glucose (Figure 3). The prevalence of diabetes in the United States is rising rapidly. The prevalence of diabetes increased from 8.9% in 1976–1980 to 12.3% in 1988–94 among adults aged 40 to 74 (12). Mexican Americans, the largest Hispanic/Latino subgroup in the United States, are more than twice as likely to have diabetes as non-Hispanic whites of similar age.
Born in Central America, I share a similar ancestry with Mexicans (Spanish and Amerindian). Not surprisingly, diabetes runs in my family. Some statistics should scare me. The lifetime risk of developing diabetes for U.S. individuals born in 2002 is about one in three for the general population, but about one in two for the Hispanic population.
The new stringent health gudiance, which also takes a dim view of oldsters, is purportedly to be applied most seriously to applicants seeking long term residence. Erm, what about H1-B visas, where holders often remain in the US for many years and hope for (but rarely get) green cards? If their employer buys health insurance, this concern is already handled. But if so, is this universal, or are there lapses?
By Amanda Seitz. Originally published at KFF 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.
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 directive is part of the Trump administration’s divisive and aggressive campaign to deport immigrants living without authorization in the U.S. and dissuade others from immigrating into the country. The White House’s crusade to push out immigrants has included daily mass arrests, bans on refugees from certain countries, and plans to severely restrict the total number permitted into the U.S.
The new guidelines mandate that immigrants’ health be a focus in the application process. The guidance applies to nearly all visa applicants but is likely to be used only in cases in which people seek to permanently reside in the U.S., said Charles Wheeler, a senior attorney for the Catholic Legal Immigration Network, a nonprofit legal aid group.
“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.”
About 10% of the world’s population has diabetes. Cardiovascular diseases are also common; they are the globe’s leading killer.
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,” the cable reads. Spokespeople for the State Department did not immediately respond to a request for comment on the cable.
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 cable’s language appears at odds with the Foreign Affairs Manual, the State Department’s own handbook, which says that visa officers cannot reject an application based on “what if” scenarios, Wheeler said.
The guidance directs visa officers to develop “their own thoughts about what could lead to some sort of medical emergency or sort of medical costs in the future,” he said. “That’s troubling because they’re not medically trained, they have no experience in this area, and they shouldn’t be making projections based on their own personal knowledge or bias.”
The guidance also directs visa officers to consider the health of family members, including children or older parents.
“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.
Immigrants already undergo a medical exam by a physician who’s been approved by a U.S. embassy.
They are screened for communicable diseases, like tuberculosis, and asked to fill out a form that asks them to disclose any history of drug or alcohol use, mental health conditions, or violence. They’re also required to have a number of vaccinations to guard against infectious diseases like measles, polio, and hepatitis B.
But the new guidance goes further, emphasizing that chronic diseases should be considered, said Sophia Genovese, an immigration lawyer at Georgetown University. She also noted that the language of the directive encourages visa officers and the doctors who examine people seeking to immigrate to speculate on the cost of applicants’ medical care and their ability to get employment in the U.S., considering their medical history.
“Taking into consideration one’s diabetic history or heart health history — that’s quite expansive,” Genovese said. “There is a degree of this assessment already, just not quite expansive as opining over, ‘What if someone goes into diabetic shock?’ If this change is going to happen immediately, that’s obviously going to cause a myriad of issues when people are going into their consular interviews.”
America has chosen democratically to have an enormously expensive medical system. We also don’t allow people to die in the streets from acute medical conditions. You don’t want to incentivize medical migration explicitly or inadvertently. Border control is an option for the US, if they choose. A little cold? of course. I prefer Europe myself. But I can afford it.
Migration to the US isn’t a human right.
Perhaps I am misinformed but I find it hard to believe that a majority of persons want to migrate to the US for the benefit of their medical system. The unpopularly enforced high medical costs and confusing health insurance system are a huge turn off, especially when medical professionals exist all over the world who can provide quality care. Isn’t it that a lot of USians leave the country for medical care? As far as I can tell from a quick search this is not uncommon and is sought out often due to health insurance being unaffordable in the US. Articles documenting the reverse practice are not appearing, on my cursory search.
Some states like California, and cities like New York, are reported to pay healthcare and other costs for the unhealthy, unauthorized, hah, arrivals. It is hard enough to pay bills already without them. First Obama healthcare and then Biden borders to add to daily duress.
“reported”
Meanwhile, a quick check in the search engine of your choice will find a thriving industry in medical tourism for Americans. Many package deals with a hotel stay and spa treatments along with the orthopedic surgery or whatever.
My taxes, and yours and others, pay for the former. The US medical tourists going to foreign countries pay their own way.
My taxes have also been paying for Andrew Cuomo’s legal team and the settlements to his victims. Oh and a whole bunch of money to various private companies rather than NASA. Then there are billions spent on assassination and government overthrow teams or proxy wars directed at foreign governments whose biggest crime is they think their country’s natural resources should enrich them and their people and not American oligarchs.
Do you want me to continue to list the numerous far more offensive and disgusting wastes of tax money rather than helping sick people? I can. Personally I believe that no one in America should go hungry or go without healthcare regardless of where they came from. Obviously your values differ.
America did not choose democratically. The votes are there for a better health system but the bought and paid for politicos won’t deliver. If you are in europe you have he same situation with ursula “text me the details” vanderlyin’
This is a very interesting article. I had no idea so many countries required health insurance for travellers. The underlying reason, to prevent spending taxpayer dollars on travellers, makes sense. I can’t argue against this but it does make travel increasingly unaffordable for many persons already barely getting by because of years of global neoliberalism. I think the solution for that will have to be a shift away from country-specific neoliberal policies to something more beneficial.
Back on topic, I think that govts have every right to limit/eliminate migration if they (and ideally the citizens) want but these policies seem extremely broad. I can’t think of how they will be implemented effectively except as a cover similar to what Yves suggested, for racial exclusivity.
As a doc, I very rarely, ever get a patient who does not have at least one chronic health condition or a family member with one. Medicine is also not cut and dry and anybody with a ‘stable’ medical condition, like controlled asthma, could suddenly experience a crisis for all kinds of reasons. Similarly, I have many patients with Schizophrenia and Bipolar Disorder who have been well controlled for years, even decades and are functioning without impairment as fellow doctors, CEOs and whatever else they feel like pursuing. I can understand requiring health insurance for persons travelling in general but rejecting people outright because they may have a health crisis seems short-sighted.
Especially when applied to persons seeking tourist visas, I can’t imagine these rules being followed to the letter and not cutting travel to the US by something like 90% (I am biased since persons seeing a doctor are more likely to have underlying issues but even among my peer the prevalence seems equal).
Regardless, whether or not this is a bad thing, the real kicker is that I can’t see these rules being enforced against people applying for slave visas or against decrepit millionaires. I doubt this will be used much at all except against specific groups, as was said. At the end of the day, it just feels like an attempt to shore up national support and say that the admin is doing more to keep out immigrants (while silently accepting the ones desperate enough to accept low wages and conditions worse than what normal employees would have agree to).
Wow, I am amazed at your factoid about the prevalence of chronic conditions. Do you consider orthopedic conditions, like sports/overuse injuries that may eventually benefit from surgery, to be “chronic conditions” or only ones with a clear lifespan impact if not addressed?
Short answer – No I wouldn’t.
Also, just to be upfront, my specialty is Psych so my knowledge here may be crude compared to an Ortho/Family Med doc.
Longer explanation-
Strictly speaking, corrective surgery if needed should definitively resolve the issue along with adherence to the Ortho/Physiotherapist’s post-surgery advice. That said, putting the affected area under a lot of stress in the future/general muscle atrophy and bone density loss with advancing age can led to a return of some symptoms.
But yes, if patients have had their symptoms totally resolved after intervention, I would not put it down as a chronic condition. The tricky ones are those who don’t fully improve even after opting for surgery, or are unable to avoid putting strain on the affected area.
I have a fair amount of patients struggling to achieve prolonged relief from Carpal Tunnel Syndrome. I would consider that as a chronic condition in my practice but from the perspective of screening out medically expensive, non-resident, ER visitors, they would be very near the bottom of my list.
Persons with things like moderate-severe Osteoporosis putting them at risk for fractures/dislocations though, I would definitely consider a risk. Other conditions like Lumbar/Cervical Spondylosis where your vertebrae are basically increasingly compressed, causing pain and potentially degrees of paralysis/numbness for eg., can be treated surgically (eg. by inserting pins to hold them apart properly) but there is always the risk of subsequent deterioration, especially without ongoing follow up and regular neck exercises (as prescribed by your Ortho/Physio only). On the other hand, patients with the above, non-sport related conditions are usually around 65 or older so this new plan for screening may not be considering them to begin with…
I would love to hear the thoughts of any other medics with more Ortho knowledge though.
Just wish the same “test” were applied to candidates for president etc. With a similar bias against oldies.
Goes to show that national policies in general vis a vis immigration are there to secure for employers healthy, obedient workers who have limited rights, if any.
The “public charge” language scares me. Which other “useless eaters” will we be legislating against by decree?
One important factor in the prevalence of diabetes in Mexico was not mentioned: the role of U.S. companies, Coca Cola particularly. Then you have the recent attempt by the AMLO government to ban unhealthy GMO corn for just this reason, that it was contributing to a health crisis in Mexico.
One would think Trump would be more sympathetic to immigrants, after all, he married two of them.
Yet, the article states, “The guidance applies to nearly all visa applicants but is likely to be used only in cases in which people seek to permanently reside in the U.S.”
For nearly all travelers from first world countries they do not need a visa for stays less than 90 days. These travelers are almost always aware of the scandalous cost of the US healthcare system and they purchase private insurance for their short stay in the US. True, some arrive but illegally stay longer than 90 days, but that’s a risk and/or problem.
Moreover, they are often aware that US hospital emergency rooms, IIRC, are only required to stabilize a patient. Additional care can be expensive.
Those poor immigrants in search of a better life in the US likely have little experience with medical professionals and have given little thought to their personal health. Trump, it appears, wants to raise the health bar in order to, in his mind, keep the freeloading deplorables out and let the wealthy foreigners in, especially those who can pay to send their kids to a US university, start a business, invest, or some other Trump approved reason.
Migrants are not granted constitutional rights to migrate to the US. Migrants have the agency to improve their lives in their home country. Some might call it a duty. Do we really want to strip countries of their human capital? Or move somewhere that welcomes them. I’m not trying to be a troll. I came to this site for the terrific Ukraine commentary, and I’m happy to stick to that. I’m also not a fan of Haitian migration, although a US politician granted them temporary rights because of a hurricane or something. Another politician decided to end it, because in certain matters an emergency is temporary, like tariffs.
In the late 1980s I sponsored a Colombian woman. I agreed to keep her employed and her not accessing US services for 5 years. I am still friends with her today and she thanks me for helping speed up her “papers.” She was required to go back to Colombia and have extensive dental work done, had a physical and updated vaccinations, and all matters of paperwork done before she returned and on her way to a green card. She got her citizenship as soon as she was able to. There was nothing racist about these requirements.
Maybe Trump should deport fatties in addition to not letting them into the country. The first one out should be Trump himself. Make America Healthy Again!!