Trump doesn’t make the legislation, but he wants it made according to his preferences, as do all presidents. Presidents are always sending budgets to Congress and always telling the representatives what to legislate and what not to legislate. They’re always making speeches with long lists of laws they want. Congress generally follows. Trump is no different than the rest. The Executive leads the Legislature. That’s the American system.
Trump’s election year statements about health care legislation more or less reveal that he wanted Ryancare. He wanted only to fiddle around the edges of Obamacare. In this respect, he’s mainstream Democrat/Republican, i.e., he believes in big government and he believes that many aspects of healthcare should be handled by federal controls, regulations and mandates. This is one reason he’s so upset with the group of 30-36 or so Republicans who are more conservative on this issue.