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\u2019t 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.<\/p>\n
Even for mere tourist visas, more and more countries are requiring travel insurance. From Forbes in October<\/a><\/p>\n Which countries require travel insurance, and why? And how do you find a policy that will be approved?<\/p>\n Argentina <\/strong>\u2026<\/p>\n Europe\u2019s Schengen Area<\/strong> 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\u2019s not a suggestion buried in fine print. It\u2019s a hard requirement.<\/p>\n \u201cAll 29 countries of the Schengen Area require all Schengen visa applicants to take out travel insurance, but not just any policy will do,\u201d explains Cl\u00e9ment Goubon, chief marketing officer of Insurte<\/a>. \u201cThe policy they choose has to meet specific criteria set by the Schengen Zone.\u201d<\/p>\n Cuba <\/strong>\u2026.<\/p>\n Ecuador and the Gal\u00e1pagos Islands<\/strong>\u2026<\/p>\n Thailand, Turkey, the UAE, and Russia <\/strong>\u2026<\/p>\n All told, 23 countries plus Europe\u2019s Schengen region, now require travel insurance, according to Insubuy<\/a>. \u201cAnd many more require some sort of coverage for certain visitors,\u201d adds spokesman Mike Farren.<\/p>\n Bottom line: There\u2019s an excellent chance that if you\u2019re crossing a border, you\u2019ll need travel insurance. And unlike the last period in when mandatory insurance was required, this one is likely to stick, say experts.<\/p>\n<\/blockquote>\n 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:<\/a><\/p>\n 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\u2026<\/p>\n 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\u201394 . 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\u20131980 to 12.3% in 1988\u201394 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.<\/p>\n 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.<\/p>\n<\/blockquote>\n 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? \u00a0 \u00a0If their employer buys health insurance, this concern is already handled. But if so, is this universal, or are there lapses?<\/p>\n By Amanda Seitz. Originally published at KFF Health News<\/a><\/strong><\/em><\/p>\n 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.<\/p>\n 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 \u201cpublic charge\u201d \u2014 a potential drain on U.S. resources \u2014 because of their health issues or age.<\/p>\n 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\u2019s health status.<\/p>\n The directive is part of the Trump administration\u2019s 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\u2019s crusade to push out immigrants has included daily mass arrests, bans on refugees<\/a> from certain countries, and plans to severely restrict the total number<\/a> permitted into the U.S.<\/p>\n The new guidelines mandate that immigrants\u2019 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>, a senior attorney for the Catholic Legal Immigration Network, a nonprofit legal aid group.<\/p>\n \u201cYou must consider an applicant\u2019s health,\u201d the cable reads. \u201cCertain medical conditions \u2013 including, but not limited to, cardiovascular diseases, respiratory diseases, cancers, diabetes, metabolic diseases, neurological diseases, and mental health conditions \u2013 can require hundreds of thousands of dollars\u2019 worth of care.\u201d<\/p>\n About 10% of the world\u2019s population<\/a> has diabetes. Cardiovascular diseases are also common; they are the globe\u2019s leading killer<\/a>.<\/p>\n 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.<\/p>\n \u201cAll of these can require expensive, long-term care,\u201d the cable reads. Spokespeople for the State Department did not immediately respond to a request for comment on the cable.<\/p>\n Visa officers were also directed to determine if applicants have the means to pay for medical treatment without help from the U.S. government.<\/p>\n \u201cDoes 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?\u201d the cable reads.<\/p>\n The cable\u2019s language appears at odds with the Foreign Affairs Manual, the State Department\u2019s own handbook, which says that visa officers cannot reject an application based on \u201cwhat if\u201d scenarios, Wheeler said.<\/p>\n The guidance directs visa officers to develop \u201ctheir own thoughts about what could lead to some sort of medical emergency or sort of medical costs in the future,\u201d he said. \u201cThat\u2019s troubling because they\u2019re not medically trained, they have no experience in this area, and they shouldn\u2019t be making projections based on their own personal knowledge or bias.\u201d<\/p>\n The guidance also directs visa officers to consider the health of family members, including children or older parents.<\/p>\n \u201cDo any of the dependents have disabilities, chronic medical conditions, or other special needs and require care such that the applicant cannot maintain employment?\u201d the cable asks.<\/p>\n Immigrants already undergo a medical exam by a physician who\u2019s been approved by a U.S. embassy.<\/p>\n They are screened for communicable diseases, like tuberculosis, and asked to fill out a form<\/a> that asks them to disclose any history of drug or alcohol use, mental health conditions, or violence. They\u2019re also required to have a number of vaccinations to guard against infectious diseases<\/a> like measles, polio, and hepatitis B.<\/p>\n 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\u2019 medical care and their ability to get employment in the U.S., considering their medical history.<\/p>\n \u201cTaking into consideration one\u2019s diabetic history or heart health history \u2014 that\u2019s quite expansive,\u201d Genovese said. \u201cThere is a degree of this assessment already, just not quite expansive as opining over, \u2018What if someone goes into diabetic shock?\u2019 If this change is going to happen immediately, that\u2019s obviously going to cause a myriad of issues when people are going into their consular interviews.\u201d<\/p>\n\n
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