A revived “public charge” standard directs officers to deny visas to people with disabilities, chronic illnesses and age-related conditions—echoing the exclusionary policies of the early 20th century.
This piece includes sanist slurs used in the late 19th and early 20th centuries.
This month, Secretary of State Marco Rubio instructed visa officers to consider obesity and other chronic health conditions, such as heart disease, cancer and diabetes, as justification to deny people visas to the United States. The guidance—along with direction that visa officers can reject visa applications for people beyond retirement age and if their dependents are elderly or disabled—is part of a “public charge” rule that allows the government to deny visas and green cards if the person might use social welfare programs or be institutionalized.
Many were outraged and shocked, observing the Trump administration’s new expansion of the “public charge” rule—directing visa officers to deny entry to people with disabilities, chronic illnesses or age-related conditions—as a modern revival of eugenic immigration policy designed to exclude, control and institutionalize disabled and marginalized people. The “public charge” rule is not new, but this new definition seeks to restrict citizenship on the basis of possible institutionalization as the Trump administration pushes for forced institutionalization of unhoused individuals and is still reeling from the longest shutdown in U.S. history started because of healthcare subsidies.
The State Department’s Nov. 6 cable told U.S. consulates and embassies they “must consider an applicant’s health. 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.”
A White House spokesperson justified the move, saying, “For 100 years, State Department policy has included an authority to deny visa applicants who would pose a financial burden to taxpayers, such as individuals who were seeking publicly-funded health care in the U.S. and could further drain resources from American citizens.”
This spokesperson is partially correct: There is a long and distressing history of denying citizenship to disabled and elderly people that the government would utilize in the social services system. The term “public charge” rule refers to people who might become a public charge of the state due to their disabilities or financial insecurity. The term actually dates back to the Immigration Act of 1882, during one of the largest periods of U.S. immigration in the late 19th and early 20th centuries.
As Section 2 of the 1882 Immigration Act read, “If on such examination there shall be found among such passengers any convict, lunatic, idiot, or any person unable to take care of himself or herself without becoming a public charge, they shall report the same in writing to the collector of such port, and such persons shall not be permitted to land.”
Nine years later, the Immigration Act of 1891 extended this more explicitly to disabled people, including anyone with a contagious disease, developmental disabilities or mental illness, along with poor people, people convicted of a crime and people who practiced polygamy.
And by 1903, another immigration act allowed a person to be deported if they became a public charge within their first two years in the country.
The “public charge” rule was further reinforced by the 1915 Supreme Court decision Gegiow v. Uhl and later the Immigration and Nationality Act enacted in 1952, which said that anyone who received social services during their first five years in the United States was liable for deportation.
The Illegal Immigration Reform and Immigration Responsibility Act of 1996 further raised the expectations of sponsors, requiring them to reimburse the government for public benefits that any immigrant they sponsored might use.
As this history showcases, denials on the basis of the “public charge” never went away—throughout the 20th and 21st centuries, the rule has been used to deny people’s entry to the U.S., especially young independent women, but under Trump’s first administration it got markedly worse. When Trump first took office in 2016, the Trump administration broadened the definition of public charge to include people who receive SNAP benefits, Medicaid, housing assistance, childcare subsidies and more. This new rule was published in 2019 and went into effect in 2020 and early 2021; President Hoe Biden ended the use of this public charge rule definition in March 2021, returning it to the older but still restrictive version.
Following Trump’s new rule, visa denials based on the “public charge” rule exploded during Trump’s first residency, rising from just over 1,000 denials in 2016 to over 20,000 in 2019, with disastrous effects: Broadening this public charge rule led many people to reduce or stop using benefits or services for themselves, the Migration Policy Institute (MPI) found. MPI researchers spoke with a number of unaccompanied children who were not citizens in three cities in the United States in summer 2022, as well as lawyers and officials who worked with them, finding that even though Biden ended Trump’s public charge rule in March 2021, people were still fearful of becoming a public charge and some families forewent medical procedures that would require financial support.
This broadening of the rule beyond the CDC’s guidance represents not only intensifying roadblocks against people seeking access to the United States, but also the administration’s explicitly ableist campaign to not only deny visas on the basis of disability but also to force people into the very institutions they are worried about funding.
Back in July, Trump signed an executive order pushing states to make it easier to lock up people with mental illness—especially those who are unhoused. The order directed Attorney General Pam Bondi to undo court rulings and agreements that limit forced institutionalization. This matters here because it shows a pattern: At the same time the administration is trying to force more disabled people into institutions, they’re also trying to bar disabled and chronically ill immigrants from entering the country at all. The July order and the November visa directive are two pieces of the same agenda.
The order has been criticized by doctors and activists at the National Disability Rights Network, the National Health Law Program, the Disability Rights Education and Defense Fund, as well as others who argue that institutionalization—a tactic long used to remove and control disabled people from public spaces—is now being used to involuntarily commit homeless individuals in order to “clean up” public spaces.
A deeper dive into the history of forced or coerced institutionalization of disabled Americans reveals this is part of a wider push of the Trump administration and Make America Healthy Again movement to register and control Americans within a predatory medical system reminiscent of the eugenics movement. Eugenics first emerged in the late 19th and early 20th century, with the goal of “improving” society through selective breeding and removing “undesirable” features or attributes from the gene pool.
Eugenics—originating from the biological determinist theories of Sir Francis Galton in 1880s—is a pseudoscience that reinforced the racist belief that Nordic, Germanic and Anglo-Saxon peoples (all white) were smarter and more worthy of survival and reproduction. Eugenics was and is deeply tied to white supremacy and efforts to “protect and strengthen” a white race by regulating who was able to reproduce and raise children, an effort that intersected racism and disability, as disability was used to justify racist exclusions of people from the United States.
By the late 1800s and early 1900s, emboldened by racist and incorrect scientific theories, eugenicists campaigned against the immigration of southern and eastern European, Asian, and African immigrants to the United States, as well as the influx of African American individuals up to the North during the Great Migration after the Civil War.
Rubio’s move to broaden the public charge rule, first enacted at the same time that the eugenics movement deeply impacted immigration policy and legislation, is no coincidence. It’s part of the Trump administration’s campaign to enact ableist violence not only against its own citizens but also anyone who seeks access to the United States.
And it’s not only ableist violence. Another proposed change to a Department of Homeland Security rule could require DNA testing on immigrants seeking citizenship, putting trans, nonbinary and intersex immigrants at risk and also raising concerns about safeguards for biometric data collected. As the proposal says, “DHS may request DNA evidence to prove or disprove an individual’s biological sex in instances where the determination will impact benefit eligibility.” It’s a deeply troubling move that mirrors how transphobia is a key part of this new eugenics movement that privileges white supremacy and Christian nationalism.
This campaign both denies people access to the United States that might be institutionalized, and institutionalizes U.S. citizens without their consent, just as the administration’s proposed DNA testing would potentially deny trans, nonbinary and intersex people access to citizenship and identification documents, while actively threatening and denying identification documentations and protections to its own trans, nonbinary and intersex citizens.
It mirrors how the growing eugenics campaign of the far-right political sphere is not only aimed at prohibiting disabled and queer immigrants’ access to the United States, but also policing, harming and institutionalizing its own citizens. While Republicans worry that people granted visas or green cards would put extra strain on the healthcare system, there must be acknowledgement from them that the U.S. government was shut down for over 50 days as Democrats fought to extend healthcare subsidies to millions of Americans.
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