There's no downfalls, other than the fact that you do need health insurance, and show proof, either a certificate from your home country insurance company, or one of those expensive jobs from Thailand.
You get 365 days stamped in each time you enter, so you do a simple border bounce on day 364 of the visa, and get stamped back in for another year (often called "the free year" as you don't pay anything) - gives you two years
The list I got is generic. Perhaps not all immigration offices enforce it, but it is a requirement. Perhaps some in that Godforsaken toilet called Isaan probably don't bother 😂