A chilling new directive issued by the U.S. Department of State has ordered visa officers to consider whether applicants seeking to live permanently in the United States might become a “public charge” based on their health conditions. The cable represents a sweeping and reactionary development of US immigration policy, one that evokes the darkest traditions of eugenics and state-sanctioned discrimination.

“You must consider an applicant’s health,” the directive 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. All of these can require expensive, long-term care.”

Under the new guidance, consular officers are instructed to ask whether a visa applicant “has 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 policy even extends to the applicant’s dependents whose medical or disability status may be used to judge the applicant’s admissibility. Officers are told to consider whether the applicant might be unable to maintain employment due to caring for sick or disabled family members.

The directive is a declaration that illness, disability, or the mere possibility of future illness can be grounds for exclusion from the United States. It empowers visa officers (state functionaries, not doctors) to speculate on medical costs, employability and longevity, transforming routine health conditions into markers of social unworthiness.

Among the conditions singled out for scrutiny is obesity, not only as a medical diagnosis, but as a “risk factor” for diseases such as asthma, sleep apnea and hypertension. The deliberate inclusion of weight, mental health and chronic disease as contributing factors in “public charge” determinations marks a profound political and cultural regression.

The State Department’s cable represents a modern revival of the 20th century eugenics doctrines that once shaped US immigration and public health policy and reached their most murderous form in Nazi Germany. By linking health status to immigration eligibility, it resurrects the pseudo-scientific belief that society must be “protected” from those deemed unfit or burdensome, a logic that historically justified sterilization, institutionalization and mass murder.

This doctrine has deep roots in US law. The Immigration Acts of 1917 and 1924 codified the exclusion of those labeled “defective” or “likely to become a public charge,” categories that encompassed physical disability, mental illness and poverty itself. These measures were championed by leading American eugenicists such as Harry Laughlin, whose work directly influenced Nazi racial policy.

The 1927 Supreme Court decision Buck v. Bell sanctioned the forced sterilization of tens of thousands of working class and disabled people under the pretext of protecting the public welfare. The same ideological framework (medicalized exclusion justified by fiscal or biological “fitness”) underlies today’s visa guidance, revealing the continuity between century-old anti-scientific and racialist conceptions and the modern-day capitalist assault on immigrants and the poor.

In 1933, Hitler’s regime enacted the Law for the Prevention of Hereditarily Diseased Offspring, mandating the forced sterilization of people with conditions like epilepsy or schizophrenia; roughly 360,000 were sterilized by 1939. This evolved into the Aktion T4 program, which systematically murdered about 250,000 disabled adults and children between 1939 and 1945, victims killed by gas, starvation or injection in hospitals that prefigured the death camps. Doctors and administrators gave these atrocities a bureaucratic medical facade.

While the current US policy is not comparable in scale or outcome, it is rooted in the same dehumanizing principle that society must be shielded from those who might impose an economic or medical “burden.” Beneath its administrative language, it marks the reemergence of eugenic ideology in US immigration policy.

This is the brutal logic of American capitalism, which places a dollar value on everything, including healthcare and human life itself. Despite trillions spent annually, tens of millions remain uninsured, and medical debt drives countless bankruptcies. In such a society, health becomes a privilege of class, while illness signifies social inferiority.

By extending this logic to immigration, the State Department codifies market values into law: only the healthy, wealthy and “productive” deserve entry. Those whose lives might entail medical costs or require care and support are excluded.

An attorney told KFF Health News, “Taking into consideration one’s diabetic or heart health history—that’s quite expansive.” Another warned the directive violates the State Department’s own Foreign Affairs Manual, which forbids rejections based on “hypothetical future scenarios.” Yet speculation about future illness is now central to decisions.

This marks a decisive break from even minimal humanitarian norms. It turns illness into guilt, where medical need means crime and vulnerability is grounds for exile.

The directive is part of a broader campaign by the Trump administration. Under the banner of “public charge,” officials aim to deter not only undocumented but all immigration by redefining dependency to include potential use of public resources, from healthcare to food assistance.

This same administration has waged war on the working class: mass federal layoffs, cuts to SNAP and housing, and attacks on science and public research. ICE agents and National Guard troops have been deployed in major cities against immigrants, turning communities into militarized zones of fear.

Trump and his fascistic allies promote social Darwinism, where the strong thrive and the weak perish. The poor, sick and elderly are cast as drains on “public resources,” not victims of inequality.

The new visa guidance fits this reactionary agenda: a society ruled by profit and national chauvinism, where only those deemed “fit” or economically useful are permitted to live and work. The companion side of this policy is war and genocide abroad.

The Democratic Party and the trade unions, meanwhile, have responded to this latest assault with silence. Not a single leading Democrat has raised a serious objection to the State Department’s directive. This silence reflects the party’s own complicity in the bipartisan assault on immigrants and the working class.

Under the Biden administration, the machinery of deportation and detention expanded. Now, as Trump reasserts his far-right agenda, the Democrats offer no resistance. They are bound to the same capitalist system that breeds inequality, militarism, and repression.

The trade unions, integrated into the corporate and political establishment, have likewise refused to defend immigrants or oppose the attacks on social programs. Their role is to police the working class, not to mobilize it.

The targeting of immigrants with chronic illnesses or disabilities is an assault on the entire working class. The ruling class tests its most reactionary measures on the most vulnerable (immigrants, the poor, the sick) before imposing them on all workers.

The logic of exclusion and disposability will not stop at the border. It reflects a capitalist class preparing for mass impoverishment, intensified class conflict and war. Just as Nazi Germany’s euthanasia programs paved the way for genocide, the Trump administration’s embrace of eugenics foreshadows new forms of social brutality.

History warns where such devaluation of human life leads. What begins as administrative exclusion ends in extermination. The State Department’s directive is not an isolated policy but a symptom of a decaying social order that treats health as a commodity and life as expendable. It marks the return of eugenics in the guise of fiscal prudence and national interest.

It must be opposed with all the strength of the working class. No faith can be placed in the Democrats, the courts or the unions. The defense of the sick, the poor and the immigrant is the defense of humanity itself. Only through socialist reorganization of society, based on human need, not profit, can the nightmare of eugenics and inequality be overcome.