Equally one which replaces 'auto' with the name of the type (and similar desugaring games) is still a C to C compiler, just running as a C23 to C99 or whatever. Resolve the branch in _Generic before emitting code as part of downgrading C11.
The lifetime annotations are an interesting one because they're a different language which, if it typechecks, can be losslessly converted into C (by dropping the annotations on the way out).
I'm not sure where in that design space the current implementation lies. In particular folding preprocessed code back into code that has the #defines and #includes in is a massive pain and only really valuable if you want to lean into the round trip capability.