On November 12, 2025, the Trump administration unveiled a sweeping new immigration directive that has sparked fierce debate across the United States and beyond. For the first time, U.S. consular officials have been formally instructed to deny immigrant visas to applicants deemed overweight or suffering from certain medical conditions—unless they can prove they have the financial means to cover their potential healthcare costs without relying on public assistance. The move, which also includes a raft of new restrictions and fees for skilled worker visas, marks a dramatic tightening of U.S. immigration policy, with far-reaching implications for would-be immigrants, American businesses, and the country’s global image.
According to guidance issued by the State Department, consular officers are now required to consider whether an applicant’s health might pose a financial burden on the American taxpayer. Specifically, the directive lists obesity, high blood pressure, diabetes, sleep apnea, cancers, cardiovascular and respiratory diseases, metabolic diseases, neurological disorders, and certain mental-health conditions as grounds for visa denial if the applicant cannot demonstrate sufficient resources to pay for their care. As the guidance bluntly puts it: “You must consider an applicant’s health. Certain medical conditions can require hundreds of thousands of dollars’ worth of care.”
The policy, as reported by Metro and Daily Mail, is part of a broader push by President Donald Trump’s administration to ensure that “our immigration system is not a burden on the American taxpayer,” as spokesman Tommy Pigott stated. “It’s no secret the Trump administration is putting the interests of the American people first. This includes enforcing policies that ensure our immigration system is not a burden on the American taxpayer,” Pigott said, confirming the legitimacy of the new directive.
The National Institutes of Health estimates that adults with obesity in the U.S. incur an additional $2,500 per year in medical care costs. Health experts cited by Daily Mail note that being overweight is linked to conditions such as asthma, sleep apnea, and high blood pressure—all of which can require extensive and expensive medical care. The guidance asks consular officials to assess: “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?”
It’s a policy that, according to the State Department, applies specifically to immigrant visas. Non-immigrant B-2 visa applicants—those who can support their medical treatments and are expected to return to their home countries—are not subject to the same restrictions. Nevertheless, the directive adds to a growing list of measures the Trump administration has enacted since returning to the White House, all aimed at tightening the rules for entry into the United States.
The crackdown extends beyond health criteria. In September, President Trump signed an executive order imposing a $100,000 annual fee on H-1B visas for skilled workers. The H-1B program, which issues 85,000 visas annually and is a lifeline for American tech companies and other industries seeking high-skilled talent, now comes with a steep price tag for employers. These visas require at least a bachelor’s degree and are designed for jobs that companies struggle to fill domestically. India has traditionally accounted for about three-quarters of H-1B recipients, according to Daily Mail.
For companies looking to expedite the process, the administration has introduced the so-called “Trump Gold Card”—a fast-track residency program available to wealthy foreigners willing to pay $1 million. Up to 80,000 of these cards are expected to be available, with the program currently in its implementation phase. Companies can also pay $2 million to speed up the visa process for an employee. President Trump has claimed the Gold Card program will raise more than $100 billion for the U.S. Treasury, funds he says will be used to “cut taxes and pay down debt,” though specifics remain unclear.
Commerce Secretary Howard Lutnick echoed the administration’s focus on attracting elite talent and investment. “Instead of people trying to take jobs from Americans, they’re going to create businesses and create jobs for Americans,” Lutnick said. He added that he had “spoken with all of the big companies and they are on board with the new mandatory payment.”
For those seeking even greater flexibility, a new “Trump Platinum Card” is set to launch, allowing holders to spend up to 270 days in the United States without paying tax on non-U.S. income—for a fee of $5 million.
The administration’s stance on immigration has not stopped at economic and health considerations. In June, Trump imposed a full ban on nationals from 12 countries—including Afghanistan, Iran, Libya, and Yemen—and partial restrictions on citizens from another seven nations. “We don’t want 'em,” Trump said in a video statement. “Very simply, we cannot have open migration from any country where we cannot safely and reliably vet and screen.” White House Deputy Press Secretary Abigail Jackson reinforced the message on X (formerly Twitter): “President Trump is fulfilling his promise to protect Americans from dangerous foreign actors that want to come to our country and cause us harm. These commonsense restrictions are country-specific and include places that lack proper vetting, exhibit high visa overstay rates, or fail to share identity and threat information.”
The crackdown has also included the deportation of hundreds of Venezuelans suspected of gang affiliation, and even a move to bar Harvard University from admitting foreign students involved in campus protests. The State Department, for its part, insists that these policies are about national security and public safety. “The Department of State is committed to protecting our nation and its citizens by upholding the highest standards of national security and public safety through our visa process,” a senior official said.
Trump’s approach to immigration has long been controversial. During his first term, he announced a travel ban targeting seven majority-Muslim countries, a policy that was eventually upheld by the Supreme Court in 2018 but repealed by President Joe Biden in 2021. Despite the backlash, Trump has continued to tout the “successes” of those initial bans, arguing that they made the country safer.
The new health-based visa restrictions have drawn both praise and criticism. Supporters argue that the measures are necessary to protect American taxpayers and ensure that immigrants do not strain the healthcare system. Critics, meanwhile, warn that the policy could be discriminatory, unfairly targeting people based on health conditions that may be beyond their control, and potentially excluding skilled workers who could otherwise contribute significantly to the U.S. economy.
The debate is likely to intensify as the policy is implemented and its full impact becomes clear. For now, one thing is certain: the Trump administration’s latest moves mark one of the most aggressive overhauls of U.S. immigration policy in recent memory, raising profound questions about the nation’s values, priorities, and future direction.
