C99 support in MSVC was still spotty until very recently. And for single-header libraries in particular it's helpful to use a style of C that can be #included directly into C++ source files without issue.
The big missing features were VLAs (those will never be implemented) and _Generic (implemented now in VS2019).
_Generic has only been added very recently in VS2019, and MS recently has pledged C11 and C17 support (but it will never be a C99 compiler because VLAs will not be implemented, that's fine though, VLAs should never have made it into the standard).
There is no rule that ISO C++ compilers should be C compilers as well.
In fact, I bet they only backtraced on their position on their C compiler due to WSL, IoT and devices like Azure Sphere.