Leaders at the American Academy of Actuaries say the individual health insurance mandate is so vital to health reform that if removed, alternatives would be needed.

"To make the provisions that restrict rating and eliminate exclusions for pre-existing conditions work, health insurance markets must attract a balanced cross-section of risks," said Cori Uccello, senior health fellow for the American Academy of Actuaries. "This means finding a way to encourage the enrollment of low-risk individuals. The individual coverage mandate may be the best tool available to achieve that."

Health reform law requires individuals to enroll in health coverage that meets basic minimum standards, beginning in 2014. A report by the nonpartisan Congressional Budget Office (CBO) forecasted in 2010 that the health insurance individual mandate will force approximately 4 million uninsured Americans to pay a sizable fine by 2016; the annual penalties will average a little more than $1,000 a piece.