A h ealth reform regulation requires insurance companies to cover birth control without co-pay. (SUSAN BIDDLE/FOR THE WASHINGTON POST)

House Republicans are opening the day with a hearing on a health reform provision that religious groups have fiercely protested: the mandated coverage of birth control without a co-pay.

Beginning next year, the health reform law will require insurance companies to cover preventive health services for women, including contraception, without a co-payment. For religious organizations that oppose contraception, there’s also a conscience clause: faith-based groups that primarily employ and serve those of the same religion can pursue an exemption.

But religious leaders say that’s too narrow; they want the conscience clause to be wider-reaching and not hinge on whom a religious institution employs or serves. That would likely allow Catholic universities and hospitals, which tend not to employ primarily Catholic populations, to qualify for the exemption. According to the Catholic Hospital Association, most Catholic hospitals do not currently provide coverage for contraceptives.

Some religious supporters of the health reform law have broken with the Obama administration n this provision. “I think anybody who works for Catholic institutions understands when they sign up to be part of an institution, there are certain values that’s organized around,” Catholic University of America’s Stephen Schneck told me in a recent interview. Schneck has supported the health reform law, but also petitioned the administration for a more expansive conscience clause on this provision.

As he puts it, “They should have used that more expansive language, which would include organizations that are driven by the religious mission.”

Women’s groups have fiercely defended the provision and opposed expanding the conscience clause in a way that could affect many women who don’t have a religious opposition to contraceptives. “Institutions that operate in the public sphere and serve the public should not be allowed to impose one particular religious view on the general public, including their employees,” writes Nancy Keenan, president of NARAL Pro-Choice America, in documents submitted for today’s hearing.

How exactly this shakes out is still to be seen. Health and Human Services published a preliminary rule on the issue in July; a final version is still forthcoming. In finalizing the regulation, the administration has many opinions to weigh: it received more than 100,000 comments on the first draft, according to one HHS official. Whatever the final decision, it will be one closely watched by those on both sides of the issue.